CORNEAL ULCERATION AS POTENTIAL COMPLICATION OF INTRASTROMAL BEVACIZUMAB INJECTION FOR CORNEAL NEOVASCULARIZATION IN LIPID KERATOPATHY

Published 2022 - 26th ESCRS Winter Meeting

Reference: P136 | Type: Abstracts | DOI: 10.82333/0wep-c387

Authors: Pablo Andres Cisneros Arias* ¹ , Constanza Caramello-Álvarez ¹ , Nuria Lopez ¹ , Maria Angeles del Buey ¹ , Enrique Minguez ¹ , Marta Cipres ¹ , Ismael Bakkali-El Bakkali ¹ , Eva Nuñez-Moscarda ¹ , Ana Boned-Murillo ¹ , Dolores Diaz-Barreda ¹ , Marta Orejudo de Rivas ¹ , Paula Casas-Pascual ¹ , Javier Ascaso-Puyuelo ²

¹Ophthalmology,Hospital Clinico Universitario Lozano Blesa,Zaragoza,Spain, ²Ophthalmology,Hospital Clinico Universitario Lozano Blesa,Zaragoza,Spain;Faculty of medicine,Universidad de Zaragoza,Zaragoza,Spain

Purpose

The purpose of this study was to report a potential complication after corneal intrastromal bevacizumab injection on corneal neovascularization in patients with lipid keratopathy secondary to long-term neurotrophic keratitis. The ulcers were fully healed and with stable epithelium prior the injection.

Setting

Bevacizumab, a full-length humanized monoclonal antibody against vascular endothelial growth factor (VEGF), has been used as treatment in lipid keratopathy with good outcomes and an adequate safety profile. To our knowledge, the only complication reported has been an uncomplicated minor intracorneal hemorrhage.

Methods

Two eyes of two patients with lipid keratopathy due to a long-term neurotrophic keratitis accompanied by corneal neovascularization received 1 dose of corneal intrastromal bevacizumab. 10 days follow-up examination not only revealed some degree of regression of corneal neovascularization and reduction in lipid deposition but also showed a corneal desepitheliazation in both patients.

Results

It was proposed to add insulin eyedrop to the topical treatment with artificial tears, antibiotics and autologous serum drops. Three weeks later, it was found a clear regression of the ulcers. The visual acuity improved and the corneas of both patients showed less opacity accompanied by neovascularization and lipid density reduction. No other problem of toxicity has been detected. Treatment will be maintained chronically and its gradual withdrawal will be evaluated. New bevacizumab injections are still considered in the future.

Conclusion

Intrastromal bevacizumab treatment is generally safe and well-tolerated and provides good outcomes. But in patients with severe neurotrophic keratopathy or epithelial defects, care must be taken. A close and vigorous follow-up is always necessary in these patients.