Corneal fine‐needle diathermy with intrastromal and subconjunctival injection of bevacizumab in a child with corneal neovascularization of herpetic origin

• Published in: Acta ophthalmologica (Oxford, England) England), 2022-12, Vol.100 (S275), p.n/a
• Main Authors: Rivasés, Guillermo Pérez, El Bakkali, Ismael Bakkali, De Rivas, Marta Orejudo, Arias, Pablo Cisneros, Moscarda, Eva Josefina Nuñez, Claveria, Julia Aramburu, Fernandez, Miguel Castillo, Martinez, Marta Suñer, Millán, Patricia Ramiro, Puyuelo, Javier Ascaso
• Format: Article
• Language: English
• Subjects: Acyclovir; Anesthesia; Antiangiogenic agents; Bevacizumab; Blood vessels; Cornea; Corneal transplantation; Edema; Inflammation; Injection; Keratitis; Monoclonal antibodies; Patients; Steroids; Stroma; Ulcers; Vascularization
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.0297

Purpose: Corneal neovascularization (CNV) in the paediatric population has a variety of etiologies including bacterial ulcers, herpes keratitis, exposure keratopathy, blepharokeratoconjunctivitis and corneal anaesthesia. Monotherapy with antiangiogenic agents or corneal fine‐needle diathermy (FND) alone do not completely resolve CNV; however, the combined treatment of these two seems to offer better results. Methods: We present the results of FND with adjuvant injection of intrastromal and subconjunctival Bevacizumab in a child with CNV of herpetic origin. Results: A 3‐year‐old patient who has been treated in our hospital for corneal involvement in the left eye (LE) due to herpetic keratitis of weeks of evolution comes to our consultation. Examination under general anaesthesia reveals in LE an inferior paracentral corneal leukoma with partial involvement of the visual axis and CNV that enters through the limbus from 5 to 8 h and begins to involve corneal stroma; no epithelial lesions, no corneal oedema or inflammatory activity in the anterior segment. After not improvement, it was decided to perform FND of lower CNV in conjunction with an intrastromal injection and another subconjunctival injection of Bevacizumab. Subsequently, it remains stable with topical and oral antiherpetic treatment, and topical corticosteroid therapy. At 3 months, the CNV reactivated, for which FND + intrastromal and subconjunctival bevacizumab was performed again. Finally, at 2 months, the patient is asymptomatic with VA LE of 1.0, with 2 corneal leukomas without CNV or epithelial lesions, and continues to be treated with oral acyclovir at prophylactic doses. Conclusions: FND of CNV together with adjuvant treatment with intrastromal and subconjunctival Bevacizumab is a good choice in children to treat those active corneal neovascularizations that do not respond to corticosteroid. References 1. Yeung SN, Lichtinger A, Kim P, Amiran MD, Slomovic AR. Combined use of subconjunctival and intracorneal bevacizumab injection for corneal neovascularization. Cornea. 2011; 30(10): 1110–4. 2. Koenig Y, Bock F, Kruse FE, Stock K, Cursiefen C. Angioregressive pretreatment of mature corneal blood vessels before keratoplasty: Fine‐needle vessel coagulation combined with Anti‐VEGFs. Cornea. 2012; 31(8): 887–92.