title: Perilimbal bevacizumab injection for interface neovascularization after deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To evaluate the effect of perilimbal bevacizumab injection on neovascularization at the interface of donor and recipient tissues after deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  This interventional case series included 4 patients with interface neovascularization after DALK (3 patients with advanced keratoconus and 1 patient with scarring because of herpetic keratitis). Bevacizumab (2.5 mg/0.1 mL) was injected subconjunctivally near the limbus adjacent to the abnormal blood vessels. Depending on regression of new vessels, injections were repeated. If neovascularization occurred in more than 1 quadrant, injections were administered at 2 sites (2.5 mg for each injection). Total corneal neovascularization, longest neovascular length, and degree of neovascular circumference were evaluated by digital slit lamp corneal photography before injection and 1 week, 1, 3, and 6 months afterward.
  
  
  RESULTS
  The mean follow-up period was 14 ± 7.52 months from the first bevacizumab injection. Corneal neovascularization, on average,was 33.70% ± 7.8% (SD) of the total corneal surface before the injections, which decreased to 4.83% ± 3.3% (P = 0.005, t test) at the last follow-up examination. Mean degree of neovascularized circumference decreased from 165 degrees before injection to 77.5 degrees (P = 0.023) at the last follow-up examination. Mean longest neovascularized length decreased from 6.714 mm before injection to 1.497 mm (P = 0.021) at the last follow-up examination. At the end of the study, all patients had clear grafts with no sign of graft failure. Mean best-corrected visual acuity before injection was 20/100, which improved to 20/30 at the last examination.
  
  
  CONCLUSIONS
  This small case series suggests that perilimbal bevacizumab injection is safe and effective for partial regression of new blood vessels at the interface of donor and recipient tissues after DALK and may effectively prevent graft rejection.
authors.affiliation: Department of Ophthalmology, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. arforoutan@gmail.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Foroutan
authors.forename: Beigzadeh
authors.initials: B
authors.lastname: Fariba
authors.forename: Bakhtiari
authors.initials: B
authors.lastname: Pejman
authors.forename: Joshaghani
authors.initials: J
authors.lastname: Mahmoud
authors.forename: Ghasemi Falavarjani
authors.initials: GF
authors.lastname: Khalil
authors.forename: Ehteshami Afshar
authors.initials: EA
authors.lastname: Arash
authors.forename: Pooria
authors.initials: P
authors.lastname: Foroutan
mesh_terms: D000293:Adolescent; D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003228:Conjunctiva; D016510:Corneal Neovascularization / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D056965:Injections, Intraocular; D016849:Keratitis, Herpetic / Q000601:surgery; D007640:Keratoconus / Q000601:surgery; D016850:Limbus Corneae; D011183:Postoperative Complications / Q000188:drug therapy; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab