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| |  Topical Bevacizumab Plus Fine-Needle Coagulation Shows Promise for Mature Corneal Vessels: Presented at AAO-PAAO By Fred Gebhart SAN FRANCISCO -- October 27, 2009 -- Topical bevacizumab plus fine needle coagulation of feeder vessels shows promise as an emerging new treatment to reduce mature corneal blood vessels, according to a study presented here October 25 at the 2009 Joint Meeting of the American Academy of Ophthalmology and Pan-American Association of Ophthalmology (AAO-PAAO). “The new option is important because until now, you didn’t have any real treatments for mature corneal blood vessels,” said coauthor Yanyan Koenig, MD, University of Erlangen-Nurenberg, Erlangen, Germany. “We saw real improvements in visual acuity and no recurrence after as long as 18 months of follow-up. We can now perform keratoplasty where we could not with the vessels in place.” There is no generally accepted treatment for mature pathologic corneal neovascularisation, Dr. Koenig noted. Because bevacizumab is known to inhibit active progressive angiogenesis in the cornea, researchers opted to try it against mature neovascularisation following coagulation of the primary feeder vessel. Dr. Koenig and colleagues treated 12 eyes of 12 patients with established corneal neovascularisation due to a variety of conditions, including herpetic keratitis, limbal stem cell deficiency following a chemical burn, corneal graft rejection, ocular pemphigoid, and lagophthalmos. Each treated eye was given fine-needle feeder vessel diathermy coagulation until the feeder vessel collapsed. Patients were also given topical eye drops containing 5 mg/mL of bevacizumab 5 times a day for up to 4 weeks following coagulation. A routine Snellen visual acuity assessment was performed at each follow-up visit, followed by an ophthalmic examination with fluorescein staining and tonometry. Changes in corneal neovascularisation were assessed by image analysis from standardised digital photographs. Four of the 12 patients had increased visual acuity and 7 patients had stable visual acuity, Dr. Koenig reported. Image analysis showed measurable regression of the feeder vessel in 10 patients. Three patients needed a second diathermy treatment, but 2 of them showed feeder vessel regression on follow-up. Of the 2 patients who did not show regression, 1 had herpetic keratitis and the other had limbal stem-cell deficiency after a chemical burn. None of the successfully occluded feeder vessels reperfused during the 15 months of follow-up reported and none of the patients complained of any drug-related ocular or systemic adverse events. Researchers reported no allergic reactions. “Patients reported that they felt comfortable during the entire follow-up period,” Dr. Koenig said. “That is subjective, but feeling comfortable is an important outcome of treatment. We also showed that you can repeat the treatment if needed. We need longer-term data, but this may be an effective way to deal with mature neovascularisation in the cornea.” [Presentation title: A New Treatment Option for Mature Corneal Blood Vessels: Fine-Needle Feeder Vessel Coagulation Combined With Topical Avastin. Abstract PO060]
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