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Iva Dekaris, Sandra Sobocanec, Maja Pauk, Marina Korolija, Natasa Draca, Nikica Gabric; Anti -VEGF and Amniotic MembraneTransplantation (AMT) Improves Corneal Graft Survival in High Risk Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6413.
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Patients with Steven-Johnson syndrome (SJS), vascularized leucoma and rejected graft have major risk for graft failure. We investigated whether penetrating keratoplasty (PK) with AMT and/or anti-VEGF (Avastin) improves graft outcome.
Out of 27 high-risk patients; 2 had SJS, 2 post-infective keratitis, 4 chemical burns, 12 vascularized scar and 7 rejected graft. Preoperative best corrected visual acuity (BCVA) was 0.01-0.3 in 17 and light perception in 10 patients. All patients underwent combined surgery. At the end of the surgery 25 patients received subconjunctival Avastin (25mg/ml) and were treated with Avastin eye drops (25mg/ml). Corneal grafts were prospectively (at least 6 months) checked for clearance and presence of neovascularization (NV), and BCVA was determined. Recipient corneal buttons excised during surgery were analyzed for the presence of VEGF in each corneal layer by ELISA. Total RNA was extracted from the individual corneal epithelium and real time PCR analysis was carried out to quantify mRNA expression of VEGF A and VEGFR1 genes. Low-risk corneal buttons obtained from keratoconus patients served as controls.
Regression of corneal NV was observed in 92.52% of patients and none had NV progression into the corneal graft. 85.2% of corneal grafts remained clear at the end of the observation period. Corneal graft reaction was seen in 22.2% of patients (6/27) and graft failure in 4 patients. BCVA of >0.4 was obtained in 44.4%, >0.2 in 33.3%, and 0.01 - 0.05 in 22.3% of patients. Recipient corneal buttons of high-risk patients secreted significantly higher levels of VEGF (2436.74 pg/ml) as compared to keratoconus (504.7 pg/ml, p<0.05). Marginal statistical significance was found in VEGFR1 with a tendency toward the up regulated VEGFR1 expression (p=0.052).
Combining PK with AMT, LCAT and anti-VEGF treatment improves the outcome of corneal graft in high-risk patients. This might be explained by early anti-VEGF treatment, aiming to suppress increased angiogenic potential mediated by VEGF in such patients.
Clinical Trial: :
Eye Clinic Svjetlost, 312009
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