Topical and Subconjunctival Bevacizumab in Corneal Neovascularization in Keratoplasty Patients Vladimir Pfeifer, Petra Schollmayer, Špela Štunf, Alenka.

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Topical and Subconjunctival Bevacizumab in Corneal Neovascularization in Keratoplasty Patients Vladimir Pfeifer, Petra Schollmayer, Špela Štunf, Alenka Lavrič Eye Hospital, University Medical Centre Ljubljana, Slovenia Authors have no financial interest

PURPOSE To report the clinical use of topical and subconjunctival bevacizumab (Avastin) in keratoplasty patients with corneal neovascularization (NV). GOAL: improving graft survival METHODS Aproval of National Medical Ethics Committee Prospective case series: 9 eyes of 9 patients with corneal transplant and corneal NV, (all patients baseline therapy with topical corticosteroids (0,1% dexamethason or 0,5% loteprednol) Three patients: subconjunctival bevacizumab 2.5mg/0.1ml single dose. Five patients: topical bevacizumab 5mg/ml 4 times daily for 1 month. One patient first received injection, followed by topical bevacizumab, repeated keratoplasty and repeated topical bevacizumab.

METHODS UCVA, BCVA, tonometry, slit-lamp examination and photography NV graded for: extent (clock hours of circumference) centricity (0 = no corneal invasion, 1 = host cornea, 2 = graft periphery, 3 = graft centre) hyperaemia (1 = low, 2 = moderate, 3 = intense) Follow up up to 6 months: before therapy, 2 days, 1 week, 1, 3, 6 months

Subconjunctival bevacizumab RESULTS Subconjunctival bevacizumab NV regressed in all patients Partial regrowth in next month, no further regrowth Adverse effects: 1 patient: persistent epithelial defect with stromal thinning no other adverse effects Time (days) Extent (clock hours) Bevacizumab injection Time (days) Centricity Bevacizumab injection Time (days) Hyperaemia Bevacizumab injection

Case 1: subconjunctival bevacizumab Graft failure (PK for chemical injury) Before injection 2 days after injection- beginning NV regression Subconj. injection

Case 1: subconjunctival bevacizumab 1 week after injection – maximal response 1 week after injection – maximal response

Topical bevacizumab RESULTS Extent (clock hours) Time (days) Topical bevacizumab NV partially regressed in 4 out of 5 patients. (no regression in patient with old nonprogressive NV) No regrowth No adverse effects were noted. Centricity Time (days) Topical bevacizumab Hyperaemia Time (days) Topical bevacizumab

Case 2: topical bevacizumab Before topical therapy 1 month on topical therapy - maximal response 3 month follow up - no NV regrowth

Case 3: topical bevacizumab Perforated corneal ulcer, extensive NV After PK, before topical bevacizumab

Case 5: topical bevacizumab 1 week on topical bevacizumab- beginning NV regression 3 months follow up 6 month follow up - no NV regrowth

CONCLUSION Topical and subconjunctival bevacizumab is effective in inhibiting and regressing corneal NV in keratoplasty patients. The greatest effect was seen in reduction of hyperaemia. The treatment seemed to have no effect on old nonprogressive corneal NV. Repeated treatment may be needed in some cases.