Topical and subconjunctival bevacizumab in corneal neovascularization in keratoplasty patients

Purpose To report the clinical use of topical and subconjunctival bevacizumab (Avastin) in keratoplasty patients with corneal neovascularization (NV). Methods Retrospective case series: nine eyes of nine patients with corneal transplant and corneal NV were studied. NV was graded for depth (superficial, deep), extent (clock hours), centricity and intensity. Three patients received subconjunctival bevacizumab 2.5mg/0.1ml. Five patients were treated with topical bevacizumab 5mg/ml 4 times daily for 1 month. One patient first received injection, followed by topical bevacizumab. Follow up was up to 6 months. Results Corneal NV partially regressed in 8 out of 9 patients. The extent decreased from 7.4±3.8 to 5.6±3.4 and from 8.7±5.8 to 5.3±4.5 clock hours after treatment in patients that received topical and subconjunctival bevacizumab respectively. The centricity changed only in one patient with eye drops. The greatest effect was seen in intensity with decrease from 2.6±0.5 to 1.4±0.9 and from 2.3±0.6 to 1±0.0 in topical and subconjunctival group respectively. One patient who received both subconjunctival and topical bevacizumab only showed response to topical treatment(decrease in intensity). NV regression was noticed 2 days after injection, response was maximal after 1 week, however NV regrowth started at 1 month follow up in all patients. Decrease in NV in topical group was seen after 1 week with maximum response after 1 month. One patient developed persistent epithelial defect 1 month after injection, no other adverse effects were noted. Conclusion Topical and subconjunctival bevacizumab may be effective in inducing regression of corneal NV in keratoplasty patients. Further studies are needed to prove the effect and its duration.