Three-year corneal graft survival rate in high-risk cases treated with subconjunctival and topical bevacizumab

Dekaris, Iva; Gabrić, Nikica; Drača, Nataša; Pauk-Gulić, Maja; Miličić, Neven

doi:10.1007/s00417-014-2851-8

Cited by 30 publications

(21 citation statements)

References 34 publications

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“…Furthermore, Fasciani et al 51 showed the safety and efficacy of preoperative treatment of corneal neovascularization with bevacizumab before HR keratoplasty. Dekaris et al 44 also found that 70% of HR grafts remained clear during 3 years of follow-up after combined subconjunctival and topical bevacizumab treatment.…”

Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 92%

Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

120

102

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The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal graft has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates due to a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered. However, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been employed for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments as well as tolerance-inducing methods show promising horizons in the management of high-risk corneal transplantation in near future.

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Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 92%

Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

120

102

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“…Just recently, we demonstrated that the fine-needle diathermy in combination with subconjunctival injection of Bevacizumab prior to high-risk keratoplasty in patients results in graft survival rates comparable to survival rates seen in normal-risk keratoplasty [63]. Moreover, a combined subconjunctival and topical Bevacizumab treatment improves the graft survival rate in 70% of high-risk transplantations during three years of follow-up [60].…”

Section: Endogenous Regulators Of Lymphangiogenesis In Corneal Transpmentioning

confidence: 81%

“…This approach has been transferred to the clinic and several studies have shown promising results following Bevacizumab treatment for corneal neovascularization in patients before and/or after penetrating keratoplasty. So, it could be shown that intrastromal application [56][57][58], topical application [59][60][61] and subconjunctival injection [62] respectively of Bevacizumab leads to a reduction in corneal neovascularization and so enables long term success of subsequent corneal transplantation after high-risk transplantation. Just recently, we demonstrated that the fine-needle diathermy in combination with subconjunctival injection of Bevacizumab prior to high-risk keratoplasty in patients results in graft survival rates comparable to survival rates seen in normal-risk keratoplasty [63].…”

Section: Endogenous Regulators Of Lymphangiogenesis In Corneal Transpmentioning

confidence: 99%

Role of Endogenous Regulators of Hem- And Lymphangiogenesis in Corneal Transplantation

Clahsen

Büttner

Hatami

et al. 2020

JCM

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Under normal conditions, the cornea, being the transparent "windscreen" of the eye, is free of both blood and lymphatic vessels. However, various diseases of the eye, like infections, can interfere with the balance between promoting and inhibiting factors, which leads to ingrowth of blood and lymphatic vessels. The newly formed lymphatic vessels increase the risk of graft rejection after subsequent corneal transplantation. Corneal transplantation is one of the most commonly performed transplantations worldwide, with more than 40,000 surgeries per year in Europe. To date, various anti-hem-and anti-lymphangiogenic treatment strategies have been developed specifically for the corneal vascular endothelial growth factor (VEGF) pathway. Currently, however, no treatment strategies are clinically available to specifically modulate lymphangiogenesis. In this review, we will give an overview about endogenous regulators of hem-and lymphangiogenesis and discuss potential new strategies for targeting pathological lymphangiogenesis. Furthermore, we will review recently identified modulators and demonstrate that the cornea is a suitable model for the identification of novel endogenous modulators of lymphangiogenesis. The identification of novel modulators of lymphangiogenesis and a better understanding of the signaling pathways involved will contribute to the development of new therapeutic targets for the treatment of pathological lymphangiogenesis. This, in turn, will improve graft rejection, not only for the cornea.

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“…Furthermore, meta-analysis of human clinical studies revealed that the corneal neovascularization area attenuated by 32% after subconjunctival injection, 48% after topical treatment and 36% overall following anti-VEGF administration [96•]. Thus, simultaneous administration of topical and subconjunctival bevacizumab might result in better corneal graft survival rate in most of high-risk patients [88]. In several animal studies application of topical and subconjunctival ranibizumab caused regression of corneal neovascularization and prevented graft rejection [97–100].…”

Section: Experimental Approachesmentioning

confidence: 99%

Update on the Management of High-Risk Penetrating Keratoplasty

Jabbehdari

Rafii

Yazdanpanah

et al. 2017

Curr Ophthalmol Rep

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Purpose of review In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Recent findings Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells transplantation is employed. Summary Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents e.g. tacrolimus, cyclosporine and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts.

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Three-year corneal graft survival rate in high-risk cases treated with subconjunctival and topical bevacizumab

Abstract: Combined subconjunctival and topical bevacizumab treatment may improve corneal graft survival rate in the majority of high-risk cases.

Cited by 30 publications

References 34 publications

Management of high-risk corneal transplantation

Management of high-risk corneal transplantation

Role of Endogenous Regulators of Hem- And Lymphangiogenesis in Corneal Transplantation

Update on the Management of High-Risk Penetrating Keratoplasty

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