Abstract
Purpose: :
Corneal neovascularization (CNV) is present in 4% of the general population and is a major risk factor for corneal graft rejection. Numerous case reports suggest benefit of bevacizumab in treating CNV. The aim of this study was to gather information necessary to conduct the first randomised placebo controlled trial to evaluate the effectiveness of subconjunctival bevacizumab in eyes with a recent onset of CNV.
Results: :
All patients received their allocated treatment with no losses to follow up. Corneal new vessel area reduced 36% (range +40% to -92%) in those patients receiving bevacizumab versus an increase of 90% (range +1394% to -58%) for those allocated placebo (ANCOVA p-value 0.007). There were 3 adverse events, two epithelial defects (one patient in each arm) and 1severe corneal graft rejection with extensive (+1384%) neovascularisation (placebo arm). Excluding this patient, the placebo group had a mean reduction in new vessels of 3%, but still a significant difference with the treatment arm (p-value 0.036). Conjunctival injection site vessel size reduced from baseline to 3 months in both arms (bevacizumab -2.2%, placebo -0.8%) and the groups were similar with regards to changes in BCVA, central corneal thickness, IOP and endothelial cell counts.
Conclusions: :
Subconjunctival bevacizumab (2.5mg) monthly is effective in the treatment of recent onset corneal new vessels. The intervention appears well tolerated with no major safety concerns observed in this study. Further studies are needed to confirm this effect and optimum treatment regime.
Clinical Trial: :
www.controlled-trials.com, ISRCTN35052615
Keywords: cornea: clinical science • neovascularization • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials