Treatment: surgical methods

Abstract

AbstractPurpose Herpetic keratitis may lead to a significant corneal scaring and loss of vision which often leads to surgical treatment, which can be both penetrating (PKP) and deep anterior lamellar keratoplasty (DALK). However, the survival of corneal grafts is hampered by the presence of neovascularization (NV) and possible recurrence of herpetic disease. In our prospective study we have used bevacizumab treatment at the end of surgery, aiming to decrease corneal NV,and consequently to increase graft survival rate.Methods Twelve high‐risk eyes undergoing PKP due to post‐herpetic corneal scar were progressively followed up for 17.54 months (range 6‐24). There were 7 females and 5 males of average age 51 and 44.28 years, respectively. All surgeries were ended by subconjunctival bevacizumab injection (25 mg/ml) under the NV. Grafts were prospectively examined for their clearance, presence of NV and endothelial cells density (ECD) loss.Results At the end of follow‐up 11 out of 12 (91.7%) of corneal grafts remained clear; corneal NV reduction was found in all eyes and ECD loss at 24 months was 26.63%. Two out of 12 (16.6%) of patients had herpetic recurrence in their graft, which was successfully treated with systemic acyclovir.Conclusion Subconjunctival bevacizumab may offer an adjunctive measure during surgical treatment of post‐herpetic corneal scars. This might be explained by suppression of the angiogenic potential mediated by VEGF in such patients.