Fasciani Romina, Mosca Luigi, Giannico Maria Ilaria, Ambrogio Simone Antonio, Balestrazzi Emilio
Ophthalmology Department, A. Gemelli Policlinic, Catholic University of "Sacro Cuore", Largo A. Gemelli 8, 00168, Rome, Italy,
Int Ophthalmol. 2015 Apr;35(2):221-7. doi: 10.1007/s10792-014-9938-4. Epub 2014 Apr 9.
The purpose of this study is to investigate whether subconjunctival and/or intrastromal Bevacizumab injections could help to prevent graft failure in high-risk keratoplasties. Twenty seven eyes of 27 patients, affected by high immune rejection risk and corneal neovascularization, were involved in this prospective interventional case-control series (case group: 14 eyes and control group: 13 eyes). Case group was submitted to a cycle of three subconjunctival and/or intrastromal injections of 5 mg/0.2 ml Bevacizumab. After a mean period of 6.36 months ± 3.38 SD from the last injection, all patients underwent keratoplasty. An adjunctive injection was performed intraoperatively at the end of the surgical procedure. Control group did not receive any Bevacizumab injection, but directly underwent keratoplasty. Each patient was submitted to a complete eye examination and corneal confocal microscopy. The absence of immune rejection signs in the graft, at clinical and confocal microscopy examination, was considered as main outcome measure. All cases showed less ocular inflammation and activity of vessels. No side effects were detected after the injection procedure. No corneal graft rejection was seen during the follow-up (mean 26.1 months ± 5.7 SD) in the case group. Six eyes of the control group showed graft rejection 3.8 months ± 1.4 SD after keratoplasty. As a conclusion, Bevacizumab injection may represent a preconditioning treatment to improve prognosis in high-risk corneal transplantation. The procedure seems to be safe and it may help to reduce the inflammatory stimulus that plays a key role in corneal graft rejection.
本研究的目的是调查结膜下和/或基质内注射贝伐单抗是否有助于预防高危角膜移植术中的移植失败。27例患者的27只眼睛，因具有高免疫排斥风险和角膜新生血管而纳入本前瞻性干预性病例对照系列研究（病例组：14只眼；对照组：13只眼）。病例组接受了一个疗程的三次结膜下和/或基质内注射5mg/0.2ml贝伐单抗。在最后一次注射后平均6.36个月±3.38标准差的时间后，所有患者均接受了角膜移植术。在手术结束时术中进行了辅助注射。对照组未接受任何贝伐单抗注射，而是直接接受角膜移植术。对每位患者进行了全面的眼部检查和角膜共聚焦显微镜检查。在临床和共聚焦显微镜检查中，移植物中无免疫排斥迹象被视为主要观察指标。所有病例的眼部炎症和血管活性均较轻。注射过程后未检测到副作用。病例组在随访期间（平均26.1个月±5.7标准差）未观察到角膜移植排斥反应。对照组的6只眼睛在角膜移植术后3.8个月±1.4标准差出现了移植排斥反应。结论是，贝伐单抗注射可能是一种预处理治疗，以改善高危角膜移植的预后。该方法似乎是安全的，并且可能有助于减少在角膜移植排斥反应中起关键作用的炎症刺激。
