Ranibizumab Injection for Corneal Neovascularization Refractory to Bevacizumab Treatment
A 32-year-old female with known corneal opacity and decreased visual acuity of the right eye, which was noticed three weeks prior to visit, was referred to our clinic. Previously, in 2008, she visited an ophthalmologist due to decreased visual acuity measuring 20 / 50, and a pannus-like elevated nodular opacity was found at the right superotemporal cornea (). Following suspicion of herpetic keratoconjunctivitis, she received two subcon-junctival and intrastromal bevacizumab (Avastin; Genentech Inc., South San Francisco, CA, USA) injections with a one month interval. Within one month after the last injection, the diameter of abnormal new vessels decreased to some degree, but the extent of corneal NV and opacity remained stationary (). Further bevacizumab treatment was abandoned because the lesion showed no improvement during the next six months and no other treatment was given to the patient for the next four years.\nAt her first visit to our clinic, the patient's best-corrected visual acuity (BCVA) measured 20 / 250 in the right eye and a central corneal opacity was observed along with new, abnormal vessels growing in from the superotemporal side (), suggestive of herpetic keratoconjunctivitis. After administration of Virgan (0.15% ganciclovir; Samil, Seoul, Korea) ointment and Gatiflo (0.3% gatifloxacin; Handok, Seoul, Korea) eye drops for six months, the patient underwent two subconjunctival and intrastromal ranibizumab (Lucentis, Genentech Inc.) injections in the right eye, with a one month interval. At two months postoperatively, there was significant decline in both the neovascular area (by 8.02%) and vessel caliber compared to the initial lesion (). Anterior segment photograph taken by a built-in camera on a surgical microscope (Leica F40; Microsystems, Wetzlar, Germany) at three months after the initial injection also revealed reduction of the lesion extent (). The BCVA was improved to 20 / 160 on her last visit at six months postoperatively and neither adverse reactions nor recurrence was apparent. Alteration in the corneal neovascular area was determined by sequential standardized digital slit-lamp pictures, which were analyzed morphometrically using image analysis software (Image J 1.40 g; Wayne Rasband at the Research Services Branch, National Institutes of Health, Bethesda, MD, USA). The procedure was approved by institutional review board of the Catholic University of Korea and the patient was provided with thorough explanation and filled out an informed consent form.