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Anti-VEGF therapy in management of corneal neovascularization
First Author: I. Chabbar MOROCCO
Co Author(s): L. Serghini A. Berraho
Corneal neovascularization is a terminal stage of several inflammatory diseases of eye anterior segment. It is a consequence of acute or chronic tissue suffering responsible for an excess of local production of proangiogenic factors. It is a severe condition with a poor prognosis. Several studies about corneal neovascularization treatment report encouraging results concerning anti-VEGF therapy. The benefits expected by patients are diverse: better prognosis for corneal transplantation, increased visual acuity, inflammation reduction and aesthetic improvement. The purpose of this study is to report the efficacy and safety of intrastromal injection of bevacizumab in the treatment of corneal neovessels.
A prospective study, conducted in the Department of ophthalmology B at Ibn Sina Hospital, concerning 10 patients presenting unilateral corneal neovascularization, not regressing under topical corticosteroids treatment (dexamethasone).
All patients underwent a complete ophthalmological examination. Corneal neovessels were classified in subepithelial (superficial), stromal and predescemetic (deep). All patients received intrastromal injections of bevacizumab, under local anesthesia, in a dose of 0.1 ml, with a concentration of bevacizumab at 25 mg / ml. Intrastromal injections were spaced a month apart. The treatment was continued until stagnation of the neovessels regression. After the injection, patients received topical antibiotic (Ofloxacin) for 5 days. All patients were controlled on day 7, day 30, day 60, day 90 and day 120.
Corneal neovascularization etiologies were infectious keratitis, corneal trauma sequelae, chemical burns, sequelae of corneal transplant rejection, dry keratitis and corneal dystrophy secondary to chronic inflammation. All patients have been treated with local corticotherapy, with insufficient efficacy. 5 patients received 3 intrastromal injections of bevacizumab spaced a month apart, 3 patients received 2 injections and 2 patients received only one injection. The evolution was marked by total regression in 60% of cases and partial response in 40%. This variability of bevacizumab response can be explained by different neovascularization etiologies, the delay between treatment and neovessels appearance and the limbus state.
This study suggests that intrastromal injection of bevacizumab may be a useful therapeutic alternative in corneal vascularization treatment. It is an additional weapon in the visual rehabilitation and a useful complement for improving visual acuity and corneal grafts prognosis with preoperative corneal neovascularization. However, additional studies are needed to specify the most suitable form and dosage and also to specify the indications, as well as the frequency and risk factors for developing possible secondary effects.
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