Post on 03-Jan-2016
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
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