University Eye Hospital Svjetlost, Croatia
Iva Dekaris has completed her medical studies at the age of 24, Ph.D. at 30, became Associate Professor at the age of 35 and Professor at 40. Her postdoctoral studies were both at the Schepens Eye Research Institute of Harvard Medical School (Boston, USA) and at the 'Ruder Boskovic' research Institute in Zagreb (Croatia). She became ophthalmic-specialist in 1999 and subspecialized in corneal and cataract surgery. From 2010 she is a President of the European Eye Bank Association (EEBA) and Medical Director of the University Eye Hospital Svjetlost. She has published 42 papers in CC journals and over 250 abstracts.
Our objective was to improve high-risk corneal graft survival rate by bevacizumab treatment following combined surgery: penetrating keratoplasty (PK) +/- amniotic membrane (AMT) +/- limbal stem-cell transplantation (LCAT). Fift y high-risk eyes were included: 13 had rejected graft ; 12 post-herpetic and 13 other vascularized scars, 6 chemical burns, 4 ulcers and 2 Steven-Johnson syndrome. All patients underwent combined surgery ended by subconjunctival bevacizumab injection (25 mg/ ml). Topical bevacizumab (2.5%) was delivered 3-4 times a day postoperatively. Graft s were prospectively (2 years) examined for clearance and presence of neovascularization (NV). Average endothelial cell loss was 22.83% aft er one, and 31.97% aft er two years (similar in all groups). Mean best corrected visual acuity had statistically signifi cant increase in all groups from 0.03 to 0.5, with the poorest visual outcome in SJS patients.VEGF levels in recipient corneal buttons were analyzed by ELISA (R&D, USA) and real time PCR analysis. 82.5% of corneal graft s remained clear at the end of the observation period. Corneal NV was reduced in 87,5% of eyes. Recipient corneal buttons of high-risk patients secreted higher levels of VEGF (2436.74 pg/ml) as compared to keratoconus (504.7 pg/ml, p< 0.05). Marginal statistical signifi cance was found in VEGFR1 with a tendency toward the up regulated VEGFR1 expression (p=0.052). Conclusions: Combination of subconjunctival and topical bevacizumab may off er an adjunctive measure to conventional treatment in high-risk patients. Th is might be explained by suppression of the angiogenic potential mediated by VEGF in such patients.