Efficacy of sub-conjunctival and topical bevacizumab in high-risk corneal transplant survival

Objective: To evaluate the effectiveness of subconjunctival bevacizumab and topical bevacizumab in preventing neovascularisation on high-risk corneal grafts. Methods: The randomised, controlled, parallel group study was carried out from February 2008 to April 2012 at Isra Postgraduate Institute of Ophthalmology and Yasin Eye Hospital, Karachi. Eyes with high-risk corneal transplantation with corneal neovascularisation were included in the trial. Patients were randomly allocated to 3 groups: A, B and C. After penetrating keratoplasty, Group A patients received subconjunctival bevacizumab (2.5 mg/ 0.1 ml), Group B, patients received sham injection, while Group C patients received topical bevacizumab (2.5%, 25 mg/ml). It was self-administered 4 times a day for 24 weeks. Group B was the control group. Corneal neovascular invasion area was measured using mathematical software programme Mat Lab. Data analyses were done using SPSS version 19. Results: Of the total 122 patients, there were 41 (33.88%) each in Group A and B, while Group C had 40 (32.78%) patients. Among the 3 groups, mean corneal neovascular invasion area was minimum in Group A (n=3; 6.23%), while in Group B it was 12.3% (n=5). Group C had the maximum corneal neovascular invasion area after 24 weks (n=11; 26.7%). Maximum number of patients (n=36; 87.80%) attained visual acuity of 6/36 or better in Group A followed by Group C (n=26; 65%) and Group B (n=17; 41.46%). Conclusion: Subconjunctival bevacizumab reduces the recurrence of neovascularisation and, thus, helps increasing the frequency of graft survival in cases of high-risk corneal transplants. When used topically, it is less effective.