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Vikram S. Brar, Monali Sakhalkar, S Balaiya, KV Chalam; Intracameral Bevacizumab Reduces Deep Stromal Neovascularization And Improves Corneal Graft Clarity. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2006.
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To demonstrate the efficacy of intracameral bevacizumab in treating deep corneal neovascularization secondary to graft failure.
We report a case of a 41 year-old male who presented with corneal graft failure demonstrating deep stromal neovascularization and central corneal opacity. He had a history of keratoconus for which he had undergone three prior penetrating keratoplasties in the affected eye. His best corrected visual acuity was 20/400. The pupil could not be visualized. Clinical improvement did not occur despite therapy with 40mg oral prednisone, hourly prednisolone acetate 1% eye drops, and a subconjunctival injection of bevacizumab (1.25mg). Subsequently, he was given 2 intracameral injections of bevacizumab (1.25mg) spaced 4 weeks apart. Topical prednisolone acetate was continued. Slit lamp photography and aqueous samples were obtained prior to and following intracameral injections.Aqueous samples were analyzed by immunobead assay using Luminex 100 IS fluoroanalyzer to detect concentration of vascular endothelial growth factor (VEGF).
There was marked reduction in the corneal stromal neovascularization and central opacification following two intracameral injections of bevacizumab. The resultant clarity allowed the pupil and iris to be visualized and the patient’s vision improved to 20/200. Pre-injection VEGF level was 7.912pg/mL, which increased to 9.308pg/mL prior to the second injection.
We report successful regression of deep stromal corneal neovascularization with improvement in graft clarity, following intracameral injections of bevacizumab. Clinical improvement in this case was not related to aqueous concentrations of VEGF which remained normal despite anti-VEGF therapy, suggesting an alternative mechanism of action in this case.
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