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Y. Koenig, F. Bock, F. E. Kruse, C. Cursiefen; Effect of Antiangiogenic Therapy of Mature Corneal Neovascularization by Feeder Vessel Coagulation and Bevacizumab Eye Drops on Visual Acuity. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5699.
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To evaluate the short-term and long-term visual acuity changes after successful treatment of mature pathologic corneal neovascularization using feeder vessel coagulation combined with topical Bevacizumab (Avastin) application.
17 patients with established corneal neovascularisation underwent fine needle feeder vessel unipolar diathermy coagulation. 10 patients received additional subconjuctival Avastin injections during the same operation session. All 17 patients were treated postoperatively for up to 4 weeks with topical Bevacizumab (Avastin) eye drops (containing 5 mg/ml Bevacizumab) 5 x/day. At each visit, a routine Snellen visual acuity assessment was performed followed by an ophthalmic examination. Changes in corneal neovascularization were assessed on standardized corneal slit-lamp photographs using image analysis software based on grey filter sampling.
12 patients (12 eyes) receiving topical bevacizumab treatment combined with feeder vessel coagulation showed stable visual acuity. 4 patients had improved visual acuity. One patient had reduced visual acuity due to enlarged lipid keratopathy (after two coagulations of the feeder vessel) despite successful treatment of corneal vascularization. Overall there was a non-significant trend to improvement of the visual acuity. Regression of the feeder vessel was observed in 15 eyes. Five patients (5 eyes) needed a second treatment. One patient underwent a third treatment.In the follow-up time up to 15 months there was no reperfusion of the occluded feeder vessel. No drug-related ocular or systemic adverse events were observed during follow-up.
This pilot study suggest combined fine-needle feeder vessel coagulation together with topical and subconjunctival Bevacizumab (Avastin) application to be a well tolerated new treatment option for mature pathologic corneal neovascularisation leading to modest improvements in visual acuity and regression of corneal neovascularization. These outcomes suggest that this treatment may be a potential new way to deal with established corneal neovascularization.
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