Department of Ophthalmology, Frimley Park Hospital, Camberley, Surrey, United Kingdom.
Cornea. 2010 Jun;29(6):691-3. doi: 10.1097/ICO.0b013e3181ba0ae2.
To describe the use of subconjunctival bevacizumab (Avastin) as an adjunctive treatment in a vascularized cornea at the time of lamellar keratoplasty to reduce the risk of graft rejection.
After a significant ocular high-velocity thermal injury, a patient developed extensive corneal scarring and a traumatic cataract. To improve vision, a corneal graft was indicated, but the presence of extensive neovascularization increased the risk of early graft rejection.
Bevacizumab was injected subconjunctivally before surgery to reduce the corneal vessel load. There was a dramatic response in terms of vessel regression, but this was short lived and the vessels quickly regrew. The subconjunctival bevacizumab injection was repeated at the time of combined cataract extraction and lamellar corneal graft surgery, and the feeder vessels were cauterized at the limbus. After 6 months, the graft remained clear of vessels.
This case is of interest because the eye was treated twice with subconjunctival bevacizumab with good short-term results in both instances but different longer-term outcomes in terms of vessel regrowth. This case suggests that the antiangiogenic effects of bevacizumab may be effectively harnessed at the time of a definitive surgical procedure, which reduces the stimulus for vessel regrowth.
描述在板层角膜移植术时，通过结膜下注射贝伐单抗（阿瓦斯汀）作为辅助治疗，以降低移植物排斥的风险。
患者因眼部受到高速热冲击而导致严重损伤，随后出现广泛的角膜瘢痕和外伤性白内障。为了改善视力，需要进行角膜移植，但广泛的新生血管增加了早期移植物排斥的风险。
在手术前通过结膜下注射贝伐单抗以减少角膜血管负荷。血管迅速消退，效果显著，但这种效果是短暂的，血管很快又重新生长。在联合白内障摘除和板层角膜移植手术时再次进行结膜下贝伐单抗注射，并在角膜缘处烧灼滋养血管。6 个月后，移植物仍无血管。
该病例很有趣，因为这只眼睛两次接受了结膜下贝伐单抗治疗，两次均获得了良好的短期效果，但血管再生的长期效果不同。该病例提示，在明确的手术治疗时可以有效地利用贝伐单抗的抗血管生成作用，从而减少血管再生的刺激。
