Clinical Analysis Of Anti-VEGF Treatment In Corneal Neovascularization Due To Keratitis

Objective: To evaluate the therapeutic effect of subconjunctival injection ofbevacizumab in corneal neovascularization due to keratitis and compare its efficacy atdifferent treatment periods.Methods: The patients from outpatient department of the First affiliated hospital ofDalian Medical University who were diagnosed with corneal neovascularization causedby keratitis and accepted the subconjunctival injection of bevacizumab treatment werestudied from September2012and March2013. Eyes of patients with cornealneovascularization caused by keratitis were categorized as treatment Group A. Eyes ofpatients with corneal neovascularization combined with corneal epithelial defect, edema,and conjunctival congestion were categorized as treatment Group B. All patientsreceived subconjunctival injection of Avastin0.1ml (2.5mg). All patients under wentcomplete ophthalmic examination including Visual acuity, intraocular pressure, slitlamp biomicroscopy. Patients were observed clinically before treatment and aftertreatment on3rd,7th,14th,21stand28thday. The corneal angiogenesis area was evaluatedby slit lamp bimicroscopy and corneal photography. The statistical analysis wasexpressed as mean±standard deviation(x±s). Preoperative and postoperative meanareas of corneal neovascularization on3rd,7th,14th,21st, and28thday were comparedusing paired t test, Differences in area of CNV between groups were compared usingLSD-t test. Results with p <0.05for the difference were considered statisticallysignificant.Results:1.20eyes of20patients aged between24-80years were studied. Theshortest corneal history was of1month and the longest was25years, and followed upwas for1month.2. There was no statistically significant difference in Visual acuity (VA) before andafter treatment (p>0.05). 3. Intraocular pressure was observed after treatment, and there was no statisticallysignificant difference (p>0.05).4. Slit lamp microscope observation:①After treatment, at different time periodschanges in corneal neovascularization were noted. The area of CNV on the3rd day aftertreatment was compared with before treatment and it was found that the regression ofcorneal neovascularization area was not obvious; there was no statistical significantdifference (p>0.05). After treatment on7th,14th,21st, and28thday respectively, cornealneovascularization areas were decreased significantly, the difference was statisticallysignificant (p <0.05).②CNV areas were compared at different time periods before andafter treatment in Group A. CNV area before treatment and three days after treatmentwas compared. Similarly, CNV area on14thday after treatment was compared withCNV area on21stday after treatment, and CNV area on21stday after treatment wascompared with CNV area on28thday after treatment and we found no statisticallysignificant difference (p>0.05). CNV area on3rdday after treatment was comparedwith CNV area on7th day after treatment and CNV area on7rdday after treatment wascompared with CNV area on14th day and we found the difference was statisticallysignificant (p <0.05). CNV areas in Group B before and after treatment at different timeperiods were compared. There was no statistically significant difference in area of CNVbefore treatment and on3rdday after treatment and (p>0.05). The difference in area ofCNV on7th,14th,21stand28thdays after treatment was statistically significant.(p <0.05),③There was reduction in percentage of CNV area in two groups at differentperiods of times. On the3rd day after treatment in Group A, CNV area decreased by0.91%, in B group CNV area decreased by0.63%. On7th day after treatment in GroupA CNV area decreased by17.30%, and in B group it decreased by13.75%. On14thdaysafter treatment in group A CNV area decreased by8.33%and in B group it decreasedby6.44%. It was observed that,3-14days after treatment, corneal neovascularizationarea reduced more in Group A than Group B.On21stday after treatment CNV areadecreased by4.26%in Group A and it decreased by8.62%in group B. On28thdayafter treatment CNV area decreased by4.06%in Group A, and it decreased by4.35%inGroup B, It was observed that21-28days after treatment, corneal neovascularizationarea reduced less in Group A than Group B.Conclusion:1.Subconjunctival injection of bevacizumab (Avastin) in cornealneovascularization caused by keratitis can cause suppression and regression of angiogenesis.2. Subconjunctival injection of Avastin is more effective in cornealneovascularization caused by keratitis combined with corneal edema than in cornealneovascularization caused by keratitis3. Subconjunctival injection of Avastin as treatment of corneal neovascularizationdue to keratitis is safe and effective.