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Angioregressive Pretreatment of Mature Corneal Blood Vessels Before Keratoplasty: Fine-Needle Vessel Coagulation Combined With Anti-VEGFs

Koenig, Yanyan MD; Bock, Felix MD; Kruse, Friedrich E. PhD; Stock, Katja MD; Cursiefen, Claus MD

doi: 10.1097/ICO.0b013e31823f8f7a
Clinical Science

Purpose: To evaluate the efficacy and safety of combined feeder vessel coagulation and topical antiangiogenic therapy using bevacizumab in the treatment of mature corneal blood vessels.

Methods: Sixteen eyes of 16 patients with mature corneal neovascularization (NV) due to different underlying corneal diseases underwent fine-needle feeder vessel coagulation by diathermy and were treated postoperatively for up to 4 weeks with topical bevacizumab eye drops (containing 5 mg/mL bevacizumab) 5 times a day. Nine patients received an additional subconjunctival bevacizumab injection at the time of cautery.

Results: The mean duration of follow-up was 276 ± 147.3 days (range, 29–464 days). Regression of the feeder vessel was observed in 14 eyes. The vascularized area was reduced significantly (P < 0.05). Combined subconjunctival and eye drop antivascular endothelial growth factor treatment was significantly more effective in reducing the vascularized area compared with antivascular endothelial growth factor eye drop therapy alone (P < 0.05). Five patients (5 eyes) needed a second treatment. Thirteen patients (13 eyes) receiving topical bevacizumab treatment combined with feeder vessel coagulation showed stable visual acuity. Two patients had improved visual acuity. One patient had enlarged area of lipid keratopathy despite successful treatment of corneal NV and thus decreased visual acuity. Overall, there was a nonsignificant improvement of best-corrected visual acuity (P > 0.05).

Conclusions: In this pilot study, fine-needle feeder vessel coagulation combined with topical bevacizumab application for treatment of mature corneal NV seemed to be a well-tolerated new treatment option to regress corneal NV. This may not only improve corneal transparency but also “preconditions” such a cornea for future keratoplasty.

*Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage, Erlangen, Germany

Department of Ophthalmology, University of Cologne, Cologne, Germany

University Pharmacy, University of Erlangen-Nürnberg, Erlangen, Germany.

Reprints: Yanyan Koenig, or Claus Cursiefen, Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany (e-mail: yanyan.koenig@uk-erlangen.deorclaus.cursiefen@uk-koeln-de).

Supported by IZKF Erlangen. The funding organization had no role in the design or conduct of this research.

The authors declare no conflicts of interest.

Received January 30, 2011

Accepted July 8, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.