Regression of Recalcitrant Corneal Neovascularization and Graft Revival With Systemic Bevacizumab: A Case Report.
Evita Muller, Poonam Sharma, Leo Feinberg et al.
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Case in brief
A 64-year-old woman developed bullous keratopathy and deep stromal corneal neovascularization after phakic intraocular lens implantation. Neovascularization persisted despite lens removal, vessel cautery, and local bevacizumab. A subsequent DMEK failed with rejection and persistent edema despite intensive topical steroids and further local treatment. After ovarian cancer was diagnosed, she received systemic bevacizumab with carboplatin and paclitaxel. The corneal vessels regressed and edema resolved; central corneal thickness fell from 1111 μm at rejection to 510 μm. Vision remained limited at 0.8 logMAR because of residual central lipid keratopathy.
What made this case unusual
The previously edematous DMEK, considered irreversibly rejected after 10 months, recovered corneal clarity alongside regression of established neovascularization after systemic bevacizumab-containing cancer therapy, following failure of local treatments.
Diagnostic / clinical pearl
Persistent corneal edema after DMEK rejection may not always indicate irreversible graft failure; in this case, corneal clarity returned as deep neovascularization regressed during systemic bevacizumab-containing therapy. The temporal association does not establish causality.