Short- and long-term safety profile and efficacy of topical bevacizumab (Avastin) eye drops against corneal neovascularization.
OBJECTIVE
To evaluate the short- and long-term in vivo safety and efficacy of topical bevacizumab (Avastin) application for treatment of corneal neovascularization secondary to a variety of corneal diseases.


METHODS
Thirty eyes of 27 patients with progressive corneal neovascularisation (not responding to conventional anti-inflammatory treatment) due to different underlying corneal diseases received topical bevacizumab (Avastin) eye drops (5 mg/ml Bevacizumab) for 0.5-12 months (five times/day on average). At each visit, a routine Snellen visual acuity assessment was performed, followed by ophthalmic examination including fluorescein staining. Changes of corneal neovascularization and vessel diameter were assessed using morphometry of standardized digital corneal photographs.


RESULTS
Five patients (five eyes) developed new corneal epithelial defects during topical bevacizumab treatment. In 22 patients, no new epithelial defects were observed. None of the 27 patients complained about any drug-related ocular or systemic adverse events during follow-up. No allergic reactions were observed. Corneal photographs of 21 eyes (19 patients) could be assessed. The mean reduction in vascularized area during treatment was 61%. The mean reduction in vessel diameter under topical Avastin therapy was 24%.


CONCLUSIONS
Off-label topical bevacizumab therapy against corneal neovascularization secondary to different corneal diseases was generally well-tolerated for up to 12 months. Bevacizumab (Avastin) eye drops inhibit corneal neovascularization, and lead to a reduction of the vessel diameter. Our results suggest that off-label use of Bevacizumab eye drops is a relatively safe and well-tolerated option for the treatment of corneal neovascularization. Care should be taken in patients with epithelial defects and neurotrophic keratopathy.
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, Germany.
Yanyan
Y
Koenig
Felix
F
Bock
Folkert
F
Horn
Friedrich
F
Kruse
Katja
K
Straub
Claus
C
Cursiefen
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000032:analysis*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D001808:Blood Vessels / Q000187:drug effects / Q000473:pathology; D003315:Cornea / Q000098:blood supply; D003316:Corneal Diseases / Q000150:complications; D016510:Corneal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004334:Drug Administration Schedule; D004358:Drug Therapy; D019573:Epithelium, Corneal / Q000187:drug effects / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016850:Limbus Corneae / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011182:Postoperative Care; D033581:Stem Cell Transplantation; D013997:Time Factors; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D009883:Ophthalmic Solutions; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab