Subconjunctival injection of bevacizumab (Avastin®) for corneal neovascularization

Purpose to study the effects of subconjunctival injection of Bevacizumab on corneal neovascularization. Methods Prospective interventional case series on 7 eyes of 7 patients who underwent subconjunctival injection with Bevacizumab. The following parameters were studied pre-op, at 1 week, 30, 60 and 90 days post-op: UCVA, BCVA, pachymetry with OCT, slit lamp examination and photographic imaging. Conjunctival impression cytology pre-op at 1 week and 9o days was done and complications were also noted. Results Pre-op diagnoses were: herpetic leucoma (4 eyes), chemical burn (2 eyes), neurotrofic keratopathy (1 eye). An informed off-label consent form prior to procedure was signed. 1.25 mg of subconjunctival Bevacizumab was injected nearest the area affected. Mean preoperative UCVA and BCVA were 0.86 and 0.44 LogMar units, improved to 0.61 and 0.26 LogMar units at 90 days post-op, respectively. Central and peripheral pachymetry improved from 532 and 623 microns pre-op, to 529 and 619 microns at 90 days post-op, respectively. All slit lamp findings and photographic imaging showed a clear regression of superficial and deep stromal corneal vascularization, with clearing of lipid deposits around the affected areas. No toxic effects were noted on conjunctival impression cytology. Conclusion Subconjunctival injection of Bevacizumab is a safe and effective procedure for the regression of superficial and deep corneal neovascularization. It may be a good alternative for patients prior to performing an optical keratoplasty or for those who are poor candidates for the same.