Transcript Document 7574501

Topical and Subconjunctival Bevacizumab
in Corneal Neovascularization in
Keratoplasty Patients
Vladimir Pfeifer, Petra Schollmayer, Špela Štunf, Alenka Lavrič
Eye Hospital, University Medical Centre Ljubljana, Slovenia
Authors have no financial interest
PURPOSE
To report the clinical use of topical and subconjunctival bevacizumab
(Avastin) in keratoplasty patients with corneal neovascularization (NV).
GOAL: improving graft survival
METHODS
• Aproval of National Medical Ethics Committee
• Prospective case series:
9 eyes of 9 patients with corneal transplant and corneal NV,
(all patients baseline therapy with topical corticosteroids (0,1% dexamethason or 0,5%
loteprednol)
• Three patients: subconjunctival bevacizumab 2.5mg/0.1ml single dose.
• Five patients: topical bevacizumab 5mg/ml 4 times daily for 1 month.
• One patient first received injection, followed by topical bevacizumab, repeated
keratoplasty and repeated topical bevacizumab.
METHODS
• UCVA, BCVA, tonometry, slit-lamp examination and
photography
• NV graded for:
– extent (clock hours of circumference)
– centricity
(0 = no corneal invasion, 1 = host cornea,
2 = graft periphery, 3 = graft centre)
– hyperaemia
(1 = low, 2 = moderate, 3 = intense)
• Follow up up to 6 months:
before therapy, 2 days, 1 week, 1, 3, 6 months
3
2
1
RESULTS
• NV regressed in all patients
• Partial regrowth in next month,
no further regrowth
• Adverse effects:
• 1 patient: persistent epithelial defect
with stromal thinning
• no other adverse effects
0
60
90
120
150
180
Time (days)
Hyperaemia
1
30
10
8
6
4
2
0
0
30
60
90
120
150
180
Bevacizumab injection
3
2
0
Bevacizumab injection
12
Time (days)
Bevacizumab injection
3
Centricity
Extent (clock hours)
Subconjunctival bevacizumab
2
1
0
0
30
60
90
120
150
180
Time (days)
Case 1: subconjunctival bevacizumab
Graft failure (PK for chemical injury)
Subconj.
injection
Before injection
2 days after injectionbeginning NV regression
Case 1: subconjunctival bevacizumab
1 week after injection –
maximal response
1 week after injection –
maximal response
RESULTS
• NV partially regressed in 4 out of 5
patients.
(no regression in patient
with old nonprogressive NV)
• No regrowth
• No adverse effects were noted.
0
60
90
Time (days)
Hyperaemia
1
30
10
8
6
4
2
0
0
30
60
90
3
2
0
Topical bevacizumab
12
Time (days)
Topical bevacizumab
3
Centricity
Extent (clock hours)
Topical bevacizumab
Topical bevacizumab
2
1
0
0
30
60
90
Time (days)
Case 2: topical bevacizumab
Before topical therapy
1 month on topical therapy maximal response
3 month follow up no NV regrowth
Case 3: topical bevacizumab
Perforated corneal ulcer,
extensive NV
After PK, before topical bevacizumab
Case 5: topical bevacizumab
1 week on topical bevacizumabbeginning NV regression
6 month follow up no NV regrowth
3 months follow up
CONCLUSION
1. Topical and subconjunctival bevacizumab is
effective in inhibiting and regressing corneal NV
in keratoplasty patients.
2. The greatest effect was seen in reduction of hyperaemia.
3. The treatment seemed to have no effect on old
nonprogressive corneal NV.
4. Repeated treatment may be needed in some cases.