Role of anti-VEGF for cornea, ocular surface disease still emerging

Chicago-Evidence for assessing the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents for treating corneal and ocular surface disease is accumulating. However, there is clearly a need for more research to define if, when, and how this therapy should be used, said Anat Galor, MD.

Dr. Galor reviewed the available literature on anti-VEGF agents for treatment of corneal neovascularization and in the management of pterygium at Cornea Subspecialty Day here during the annual meeting of the American Academy of Ophthalmology.

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Findings of studies to date indicate that anti-VEGF treatment-either topically or as a subconjunctival injection-appears to have a positive effect on corneal and conjunctival blood vessels, she said.

However, the ability to change the course of disease is unclear and there seem to be potential safety concerns, particularly with topical administration, said Dr. Galor, associate professor of ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.

Regarding use in pterygium management, perioperative treatment with an anti-VEGF agent does not appear to prevent recurrence according to the findings of a recent meta-analysis on this topic.

In addition, results of several studies, including one conducted by Dr. Galor and colleagues, suggest that anti-VEGF treatment for early recurrent pterygium improves hyperemia, but only transiently, and has mixed effects on area of neovascularization.

Based on available published information, Dr. Galor said that currently she uses an anti-VEGF agent together with other therapies (e.g., steroids, antiviral agents for herpetic disease) to reduce active corneal neovascularization in patients who are candidates for transplantation. Knowing that response is not guaranteed, she also uses it for managing patients with bothersome hyperemia after pterygium surgery.

Dr. Galor acknowledged that others may have different ideas about using anti-VEGF agents for management of cornea and ocular surface disease, and she emphasized the need for more information to guide patient care.

“In addition to establishing a role for this treatment, there are a lot of questions about the appropriate dose, the appropriate timing, and the route of administration,” Dr. Galor said. “As with anything else that is new in our toolbox, as clinicians continue to use the anti-VEGF agents, we will have more evidence to help provide answers.”