1. 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

2. 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.

3. 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

4. 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

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

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

7. 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

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

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

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

11. 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.