Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7337
Peer-review started: July 27, 2023
First decision: September 26, 2023
Revised: September 26, 2023
Accepted: October 8, 2023
Article in press: October 8, 2023
Published online: October 26, 2023
Processing time: 90 Days and 5.3 Hours
Corneal neovascularization (CoNV) is a condition of pathological vascular ingrowth into the cornea from the limbus, causing the avascular structure to become non-transparent and further markedly threaten the visual acuity. Various treatment approaches, including anti-inflammatory drugs (e.g., steroids and immunomodulators), laser ablation, photodynamic therapy, diathermy, and ocular surface restoration, have been used in CoNV management. These approaches are not without problems.
Several randomized controlled trials and non-randomized trials examining the efficacy of anti-vascular endothelial growth factor (VEGF) in CoNV have been published in the past few years.
We conducted an updated systematic review and meta-analysis of clinical trials to examine the efficacy and safety of anti-VEGF in CoNV.
Relevant studies published before October 2022 were identified by systematic search using PubMed, EMBASE, and Cochrane Library databases.
In this study, we found evidence demonstrating that anti-VEGF agents, mainly bevacizumab, are an effective and safe treatment for CoNV.
Anti-VEGF agents significantly reduced CoNV, BCVA, and graft rejection/failure rate compared with placebo. There was a non-significant trend toward reduction of the risk of developing corneal epithelial defects in the bevacizumab group compared with placebo. Also, combined remedies with bevacizumab have better efficacy in reducing CoNV compared with single other treatments.
Anti-VEGF agents reduce CoNV of all causes and prevent the corneal graft from rejection and failure in corneal transplantation patients. However, the most appropriate dosage and route of administration remain uncertain. Also, the number of human trials or studies for anti-VEGF drugs other than bevacizumab is limited. Additional trials and studies with larger sample sizes are needed to clarify these issues.