Subconjunctival Bevacizumab and Fluorometholone to resolve infectious

keratitis and decrease corneal neovascularisation: randomized trial

Authors Prakashchand Agarwal MD,FRCS

Namrata Sharma MD Jeewan S Titiyal MD T. Velpandian PhD

Rasik B Vajpayee MS, FRCS(Edin), FRANZCO

The authors do not have any Financial Interest in the Drugs and Products mentioned

Introduction

• Infectious keratitis heals with vascularisation and corneal opacification.

• Various drugs such as steroids and non steroidal anti-inflammatory drugs have been used to limit corneal vascularisation and subsequent opacity.

• The new generation anti-VEGF have been tried to improve the prognosis in conditions which induce corneal neovascularisation.

Aim of the study

• To study the comparative effects of bevacizumab (Genentech, San (Genentech, San Francisco)Francisco) and topical Fluorometholone (0.1%) in decreasing vascularisation in resolving infectious keratitis.

• Prospective randomized trial.

Method

• In a prospective randomized study the patients with resolving infectious keratitis were divided into two groups.

• Parameters noted were size of opacity, caliber and extent of corneal vessels by clinical photographs evaluated by two independent observers.

Method

• Group A (10 patients) received two injections of subconjunctival bevacizumab (2.5 mg in 0.1 ml) 7 days apart with topical Fluorometholone (0.1%) TDS for 4 weeks in the affected eye.

• Group B (10 patients) received topical Fluoromethone (0.1%) TDS for 4 weeks in the affected eye.

Results • Decrease in extent of corneal vessels was

28 + 3.2% in group A and 20.4 + 2.4 % in group B. 

• Decrease in size of opacity was 24.2 + 3.4 % in group A and 18.2 + 4.2 % in group B.

• Decrease in density was noted in 60% patients in group A and 40% patients in group B.

 

Intraoperative Photos

Bevacizumab injected subconjunctival 2mm behind limbus at the most vascular quadrant

Subconjunctival bleed as a complication of injection

Subconjunctival Avastin

Post injection at 12 weeks Pre-injection resolving keratitis

Fluoromethalone

Pre – treatment Corneal vascularisation Post treatment at 12 weeks

Complications• Subconjunctival bleed was seen in 3 cases who

received bevacizumab.

• Pain was experienced by 4 patients who received injection.

• Secondary glaucoma was seen in 4 cases which was controlled with timolol (0.5%) during the treatment period.

• No other major complication was noted.

Conclusions

• Subconjunctival bevacizumab helps to decrease corneal neovascularisation and decrease residual corneal opacity in a patient of resolving infectious keratitis.

• Case selection should be appropriate

• Fungal keratitis were excluded due to risk involved with use of steroids

Correspondence

Dr. Namrata Sharma

Dr Rajendra Prasad Centre for Ophthalmic Sciences,

All India Institute of Medical Sciences, New Delhi.

Email: namratasharma@gmail.com