Bevacizumab in High-Risk Corneal Transplantation: A Pilot Multicenter Prospective Randomized Control Trial

purpose: to determine the efficacy of local (subconjunctival and topical) bevacizumab (avastin) treatment in patients undergoing vascularized high-risk corneal transplantation. design: pilot, prospective, randomized, double-blind, placebo-controlled clinical trial conducted at 5 clinical centers in the united states, India, and brazil.participants: patients aged > 18 years undergoing high-risk penetrating keratoplasty, defined as corneal neovascularization (NV) in 1 or more quadrants >= 2 mm from the limbus or extension of corneal NV to the graft-host junction in a previously failed graft.methods: patients were randomized to receive subconjunctival bevacizumab (2.5 mg/0.1 ml) or placebo at the time of surgery, followed by topical bevacizumab (10 mg/ml) or topical placebo, administered 4 times per day for 4 weeks. main outcome measure: the 52-week endothelial immune rejection rate.rm results: ninety-two patients were randomized to receive bevacizumab (n = 48) or control (n = 44). the 52-week endothelial rejection rate was 10% in the bevacizumab group and 19% in the control group (P = 0.20). post hoc, extended follow-up at the lead study site showed an endothelial rejection rate of 3% in the bevacizumab group and 38% in the control group (P = 0.003). treatment with bevacizumab was found to have a hazard ratio of 0.15 (95% confidence interval, 0.03-0.65, P = 0.01) in a post hoc cox regression analysis. conclusions: In patients undergoing vascularized high-risk corneal transplantation, there was no statistically significant difference in the rate of endothelial rejection at 1 year in the bevacizumab treatment group compared with the control group. this study may have been underpowered to detect a difference between treatment groups, and taken together, our data suggest that, in the current trial design, bevacizumab has a positive but not (yet) significant effect on endothelial rejection.