Avastin: a new hope for corneal transplant patients?

Topical bevacizumab (Avastin) has shown excellent preliminary results and good topical tolerance when used in the prevention of corneal transplant failure, according to Jose Güell and Merce Morral, from Instituto de Microcirugìa Ocular (IMO) de Barcelona, Spain, speaking at "The endothelium: new surgical and medical concepts" symposium.

Irreversible immune rejection is one of the leading causes of corneal graft failure. Preoperative measures to prevent graft rejection aim to minimize the antigenic difference between the host and the donor tissues, while a careful and precise surgical technique including centration of the graft, optimal suturing and sound graft-host application may also contribute to the prevention of graft rejection.

In order to reduce deep stromal vascularization of the host cornea, Dr Güell is subconjunctivally injecting 0.1 mL of Avastin, beginning with its use under topical administration, and his results with the off-label agent have been promising so far.

Dr Güell advised that topical and systemic steroids remain the standard for the prevention of corneal graft rejection, while oral azathioprine, cyclosporine (CsA) and other immunosuppressive drugs such as FK506 and mycophenolate mofetil are also clinically used for prevention. Sustained release drug delivery systems (DDS) of CsA and FK506 have been developed to avoid systemic side effects while maintaining therapeutic levels in the anterior segment of the eye.

Dr Güell concluded that although there have been developments in the improvement of pharmacological strategies to prevent corneal transplant, further research is needed to find new agents with better efficacy and safety.