title: Clinico-biochemical correlation of the effect of subconjunctival bevacizumab for corneal neovascularization.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of clinical and biochemical effects of subconjunctival bevacizumab injection in eyes with corneal neovascularization (CNV) due to varied etiologies.
  
  
  METHODS
  This prospective interventional case series included 12 eyes of 12 patients with CNV after failed therapeutic penetrating keratoplasty (4 eyes), viral keratitis (4 eyes), adherent leucoma (2 eyes), and pseudophakic bullous keratopathy (2 eyes). Each eye received 3 doses of 1.25 mg (0.05 mL) of bevacizumab at 1-month intervals. Morphological changes in neovascularization were evaluated at each visit by slit-lamp examination and corneal digital photography. Corneal buttons of 4 eyes that underwent optical penetrating keratoplasty after bevacizumab injections were analyzed for vascular endothelial growth factor (VEGF) expression and were compared with untreated vascularized and normal cadaveric donor corneas.
  
  
  RESULTS
  Of the 12 patients, 10 were males and 2 were females. Four eyes received injections in the early phase of vascularization (<12 weeks of onset) of which 3 showed regression of vessels. Eight eyes received bevacizumab in the mature phase (>12 weeks) of which 5 showed regression. The follow-up ranged from 1 to 16 months. Five eyes underwent optical penetrating keratoplasty after receiving the last dose of bevacizumab and maintained graft clarity with no episodes of rejection over a mean follow-up of 9.8 months. Four of these 5 corneal buttons analyzed for VEGF expression revealed clinically significant lower levels of expression as compared with the vascular untreated corneas. No local or systemic adverse effects were noted in any patient.
  
  
  CONCLUSIONS
  Subconjunctival bevacizumab helps to regress CNV due to a decrease in corneal VEGF levels and might prove beneficial for use in clinical conditions leading to CNV.
authors.affiliation: *C. J. Shah Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, India; and †R. S. Mehta Jain Department of Biochemistry and Cell Biology, Vision Research Foundation, Chennai, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Agarwal
authors.forename: Narayanasamy
authors.initials: N
authors.lastname: Angayarkanni
authors.forename: Geetha
authors.initials: G
authors.lastname: Iyer
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Srinivasan
authors.forename: Radhika
authors.initials: R
authors.lastname: Natarajan
authors.forename: Sanket
authors.initials: S
authors.lastname: Charola
authors.forename: Sumathi
authors.initials: S
authors.lastname: Arumugam
authors.forename: Prema
authors.initials: P
authors.lastname: Padmanabhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D003228:Conjunctiva / Q000187:drug effects; D016510:Corneal Neovascularization / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D056965:Injections, Intraocular; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012333:RNA, Messenger / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors / Q000235:genetics; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D012333:RNA, Messenger; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab