Clinical ScienceClinico-biochemical Correlation of the Effect of Subconjunctival Bevacizumab for Corneal NeovascularizationAgarwal, Shweta MD; Angayarkanni, Narayanasamy PhD; Iyer, Geetha FRCS; Srinivasan, Bhaskar MD; Natarajan, Radhika FRCS; Charola, Sanket MSc; Arumugam, Sumathi MD; Padmanabhan, Prema MD Author Information *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. Reprints: Shweta Agarwal, MD, C. J. Shah Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai 600 006, Tamil Nadu, India (e-mail: [email protected]). The authors have no funding or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.corneajrnl.com). Received March 11, 2014 Received in revised form May 28, 2014 Accepted June 01, 2014 Cornea: October 2014 - Volume 33 - Issue 10 - p 1016-1021 doi: 10.1097/ICO.0000000000000198 Buy SDC Metrics Abstract Purpose: 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. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.