title: Corneal graft surgery combined with subconjunctival bevacizumab (avastin).
abstract: OBJECTIVE
  To describe the use of subconjunctival bevacizumab (Avastin) as an adjunctive treatment in a vascularized cornea at the time of lamellar keratoplasty to reduce the risk of graft rejection.
  
  
  METHODS
  After a significant ocular high-velocity thermal injury, a patient developed extensive corneal scarring and a traumatic cataract. To improve vision, a corneal graft was indicated, but the presence of extensive neovascularization increased the risk of early graft rejection.
  
  
  RESULTS
  Bevacizumab was injected subconjunctivally before surgery to reduce the corneal vessel load. There was a dramatic response in terms of vessel regression, but this was short lived and the vessels quickly regrew. The subconjunctival bevacizumab injection was repeated at the time of combined cataract extraction and lamellar corneal graft surgery, and the feeder vessels were cauterized at the limbus. After 6 months, the graft remained clear of vessels.
  
  
  CONCLUSIONS
  This case is of interest because the eye was treated twice with subconjunctival bevacizumab with good short-term results in both instances but different longer-term outcomes in terms of vessel regrowth. This case suggests that the antiangiogenic effects of bevacizumab may be effectively harnessed at the time of a definitive surgical procedure, which reduces the stimulus for vessel regrowth.
authors.affiliation: Department of Ophthalmology, Frimley Park Hospital, Camberley, Surrey, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Symes
authors.forename: Thomas R G
authors.initials: TR
authors.lastname: Poole
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002386:Cataract / Q000209:etiology; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000187:drug effects*; D065306:Corneal Injuries; D016510:Corneal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D016039:Corneal Transplantation; D005126:Eye Burns / Q000209:etiology / Q000601:surgery*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D008297:Male; D018918:Phacoemulsification; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab