Anti-VEGFS may have a role in the treatment of paediatric corneal neovascularisation

Anti-VEGF agents represent a good option in the treatment of corneal neovascularisdations in children , said Samer Hamada FRCS told a joint symposium of the European Paediatric ophthalmology Society (EPOS) and   the world society of paediatric ophthalmology and strabismus (WSPOS), held at the XXXI Congress of the ESCRS in Amsterdam.

“Our experience indicates that success with these agents depends on the time of intervention and the nature of disease activity giving rise to the new vessels,”  Dr Hamada Queen Victoria Hospital West Sussex UK, London, UK

Dr Hamada noted that the cornea usually remains avascular due to delicate balance between anti- angiogenic and angiogenic factors. The most frequent cause of vascularisation is hypoxia and inflammation.  Angiogenic factors are released in the cornea by by epithelial and endothelial cells, keratocytes, and by the new corneal vessels themselves. The enzymatic degradation of basement membrane of perilimbal vessels causes vascular endothelial cells to migrate and proliferate to form new vessels, Dr Hamada explained.

He noted that other treatments like steroids are not always effective and entail certain complications. Anti-VEGF agents like bevacizumab appear to be relatively non toxic to the cornea. However, when applied topically on a daily basis can lead to recurrent erosions and corneal thinning if used for over a month.

At his own centre he and his associates have used bevacizumab very selectively by subconjunctival administration.  Their results indicate that it has limited efficacy with established post-graft neovascularisations but is more effective as an adjunctive therapy in eyes receiving a second graft as a prophylaxis against the formation of new vessels.

“What we have yet to learn is the long term safety and efficacy of these agents, the best dosing frequency intervals and the best route of administration,” he added.