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Title	Fine needle diathermy with adjuvant bevacizumab: a synergistic therapy for (established) corneal neovascularization.
Abstract Nr.	2084

Purpose	To report our experience of the use of fine needle diathermy (FND) with subconjunctival bevacizumab for the treatment of established corneal neovascularization (CoNV).
Methods	Retrospective analysis of cases treated between 2015 and 2017.
Results	Nine eyes of 9 patients (mean age 44y) with mature CoNV due to herpes simplex keratitis (HSK) (n=7) and blepharokeratoconjunctivitis (n=2), previously treated with antiviral drugs and steroids, underwent FND to prevent HSK relapse, decrease lipid deposition, stabilize corneal thinning and scarring and increase survival of planned corneal grafts. Adjuvant subconjunctival bevacizumab was administrated in 7 patients. Pretreatment of CoNV before keratoplasty was performed with and without bevacizumab, respectively, in 1 and 2 patients. At the end of follow-up (median 23 weeks (W)) vessel occlusion persisted in 7 patients (78%). Two patients, 1 with and 1 without bevacizumab, suffered from CoNV recurrence, respectively, 14.5W and 21.5W after treatment. Both presented with deeper localized untreated small corneal vessels. Reactivation of HSK without new CoNV occurred in 1 patient 28W post-FND and leaded to progression of scarring. Lipid deposition was observed in 7 patients (78%) before treatment and remained stable. FND preparation for keratoplasty resulted in graft survival of 21W (end of follow-up) and 68W, respectively, with and without bevacizumab. Nobody underwent retreatment. All patients showed a corneal whitening around the needle entry and 3 patients (33%) had a small intracorneal hemorrhage, both were transient.
Conclusion	Combined use of FND with subconjunctival bevacizumab is effective and safe in occluding mature corneal vessels due to different causes and prevents new CoNV complexes.
Conflict of interest	No

Authors 1

Last name	HOUBEN
Initials	I
Department	UZ Leuven
City	Leuven

Authors 2

Last name	FOETS
Initials	B
Department	UZ Leuven
City	Leuven

Authors 3

Last name	HUA
Initials	MT
Department	UZ Leuven
City	Leuven