A Pilot Study: Evaluation Of The Effect Of Intrastromal Injection Of Bevacizumab On Vascularized Corneal Opacities Using Optical Coherence Tomography Angiography.

To evaluate the effect of intrastromal injection of bevacizumab using the swept source Optical Coherence Tomography Angiography on corneal neovascularization.

Memorial Institute for Ophthalmic Research, Cairo, Egypt.

Pilot study was done in a cohort, prospective manner. The study was done on 10 eyes of 10 patients with corneal neovascularization who were scheduled for keratoplasty or have done previous keratoplasty. Intrastromal injection of bevacizumab using a 30 Gauge needle at a concentration of 5 mg/0.2 mL [2.5%] was done for patients involved in this study. OCTA was done 48 hours before injection, 1 week and 1 month after injection. OCTA images were compared to evaluate the effect of intrastromal bevacizumab on corneal neovascularization.

at 1 week post-operative, 9 cases have shown decreased corneal neovascularization, with only 1 case that showed no regression. At 1 month period, 8 cases re-vascularized, 1 case had complete regression and 1 case have stayed the same. Using OCTA colored, black and white images we were able to picture blood vessels in 3-D image and detect subtle changes in corneal neovascularization even under vascularized scars. Using the OCTA cross-sectional images, we were able to estimate the vessels depths. 6 cases in the posterior 25% of the cornea (Deep), 2 cases in the anterior 25 % (Superficial) and 2 cases between the anterior 25 % and the posterior 25% (Mid-stromal). Vessels density was not possible to calculate in this study.

Bevacizumab intrastromal injections seem to be an effective and tolerable method in decreasing corneal neovascularization despite the level of neovascularization. OCTA added an immense value as a method of evaluation of intrastromal bevacizumab injections on corneal neovascularization.