Management of Corneal Neovascularization After Cement Injury

Friday, April 25, 2014
KIOSKS (Boston Convention and Exhibition Center)
Tanuj Banker, MD, Georgetown, Washington, DC, USA
Michael E. Summerfield, MD, Georgetown University/Washington Hospital Center, Chevy Chase, MD, USA
Michael Korchak, MD, Georgetown-Washington Hosp Ctr, Arlington, VA, USA
Jay Lustbader, MD Washington, DC, USA
Rosan Choi, MD Falls Church, VA, USA
Aruoriwo M. Oboh-Weilke, MD, Georgetown University Hospital, Washington, DC, USA

Narrative Responses:

No previous work has examined the use of anti-VEGF agents in the treatment algorithm for management of corneal neovascularization after cement injury.  We present a case of successful regression of neovascularization following the injection of bevacizumab after cement splash.

Case report of a 35-year-old construction worker who suffered a cement splash to the eye while working without protective eyewear and who developed extensive corneal neovascularization. Initially, the eye was irrigated, and extensive debridement of concrete and removal of necrotic conjunctive were performed.  Ocular exams including visual acuity, anterior segment and retinal exams were performed.  Number of subconjunctival injections of bevacizumab were documented.

In the initial post injury period, visual acuity improved from 20/200 to 20/40 with re-epithelialization of the injured cornea.  However, despite treatment with topical steroids, at two months, the visual acuity had worsened to 20/400 and extensive corneal neovascularization had developed.  Subconjunctival bevacizumab injection (1.5mg/0.05mL) was performed and after four weeks, corneal vessels had thinned. Eight weeks later, a second bevacizumab injection (2.5mg/0.05mL) was administered, and at twelve-week follow-up after the second injection, visual acuity improved to 20/70.  There was significant regression of corneal neovascularization and decreased stromal haze.

Subconjunctival bevacizumab should be considered for treatment of corneal neovascularization following chemical injury and may help with regression of corneal vasculature.