Abstract
Purpose :
Corneal neovascularization significantly increases the risk of immune-mediated allograft rejection after penetrating keratoplasty. To determine whether preoperative reduction of corneal neovascularization by fine-needle thermal cauterization combined with subconjunctival injection of bevacizumab can reduce the incidence of corneal allograft rejection after subsequent keratoplasty.
Methods :
Single center uncontrolled retrospective analysis (February 2012 - July 2018). Patients with corneal neovascularization in at least one corneal quadrant were included. To reduce corneal neovascularization prior to penetrating keratoplasty, eyes were treated by thermal fine-needle cauterization and subconjunctival injection of bevacizumab (2.5 mg in 0.1 ml). Treatment was repeated in cases of visible reperfusion of feeder vessels. Afterwards, penetrating keratoplasty was performed. When corneal neovascularization was still present on the day of keratoplasty, additional vessel cauterization was performed. Main Outcome: Incidence of corneal allograft rejection.
Results :
31 eyes of 31 patients were included. In 18 eyes, corneal vessel cauterization with subconjunctival injection of bevacizumab was performed once, whereas 13 eyes required re-treatment due to reperfusion of occluded vessels. No intra- or postoperative complications were observed. In 23 eyes, corneal neovascularization was still present on the day of keratoplasty and simultaneous vessel cauterization with subconjunctival bevacizumab injection was performed. During follow-up (mean follow-up time: 560 days; range: 59 - 1095 days), 4 graft rejection episodes in 4 eyes were observed. Calculated probabilities of corneal graft survival were 92.9% after 1 year, 78.4% after 2 years, and 78.4% after 3 years for all eyes. No immune reactions occured in patients with vessels regressed at time of keratoplasty.
Conclusions :
Angioregressive treatment of pathological corneal vessels by thermal fine-needle cauterization combined with subconjunctival injection of bevacizumab prior to high-risk penetrating keratoplasty results in graft survival rates that are comparable to survival rates seen in normal-risk keratoplasty.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.