Subconjunctival bevacizumab for corneal neovascularization

Purpose: This work aimed to study and evaluate the effect of subconjunctival bevacizumab injection in patients with corneal neovascularization (CNV) resulting from different ocular surface disorders. Methods: Ten eyes with CNV caused by different ocular surface disorders were studied. All eyes had both major and minor vessel CNV caused by factors such as healed corneal ulcers, long-standing chronic inflammatory diseases and corneal ischaemia (caused by contact lenses). All eyes received a single subconjunctival injection of 2.5 mg (0.1 ml) bevacizumab. Morphological changes in the major and minor vessels were evaluated using slit-lamp biomicroscopy and corneal photography. Results: Conspicuous recession of the minor vessels of CNV was observed in all eyes at 2 weeks post-injection. The extent of CNV of the major vessels was significantly decreased at 2 weeks post-injection. The level of CNV continued to decrease noticeably for 3 months and then stabilized for the remainder of the 6-month follow-up period. Parameters used for evaluation included the total area of CNV, which amounted to 14.0 +/- 5.4% of the corneal surface pre-injection, compared with 9.4 +/- 3.9% post-injection (p < 0.01), reflecting a mean decrease in CNV of 33 +/- 8%, and the extent of neovascularization, which decreased from 4.3 +/- 1.5 clock hours pre-injection to 2.4 +/- 1.1 clock hours post-injection (p < 0.01). During the 6-month follow-up, none of the 10 eyes showed any complication that could be related to subconjunctival bevacizumab injection. Conclusions: Bevacizumab can be used safely and effectively for CNV resulting from different ocular surface disorders. It represents an effective treatment for minor vessel neovascularization caused by long-standing chronic inflammation (e.g. trachoma) or long-standing corneal ischaemia (e.g. contact lenses), as well as for major vessel neovascularization resulting from different causes. Bevacizumab was well tolerated over the 6-month follow-up period.