VEGF inhibitors may help prevent corneal graft neovascularization and rejection

The inhibition of vascular endothelial growth factor (VEGF) receptors has ushered in a new era in clinical ophthalmology. Motivated by the dramatic results seen in such diseases as choroidal neovascularization, clinicians have been eager to apply this class of medications to other diseases. The current report describes the treatment with a single subconjunctival injection of 2.5 mg of Avastin (bevacizumab) of three patients with corneal neovascularization and an active incipient graft rejection following keratoplasty.

Each patient developed a transient decrease in neovascularization following bevacizumab treatment, but ultimately the pathologic vessels recurred and the corneas failed. A control patient with an old rejected corneal graft and longstanding corneal vessels also received the same bevacizumab treatment and demonstrated minimal or no response.

The short-lived effect of bevacizumab in the other three patients suggests that a sustained inhibition of VEGF activity would be required to have a lasting effect on corneal neovascularization. Studies on the delivery of VEGF via repeated topical or subconjunctival administration, higher concentrations, or longer lasting molecules (such as VEGF traps) are necessary to determine if VEGF inhibition will gain a prominent role in the treatment of corneal disease.