0. still develop severe immune reaction against the graft and even

Microtubules , 0 Comments

0. still develop severe immune reaction against the graft and even immunosuppressive therapy cannot help much in the graft survival in such cases.3 Many investigations have been carried out to modulate this immune reaction in order to improve keratoplasty results, including prevention of further angiogenesis.4,5 Many molecular factors have been identified in different studies, that can be important elements in angiogenesis.6 One of the factors identified related to neovascularization is Vascular endothelial growth factor (VEGF).4 Many VEGF inhibitors have been identified and are used for many retinal disorders,7 one of such VEGEF inhibitor is Bevacizumab. Considering the effectiveness of Bevacizumab as an anti VEGF, it has been investigated as a possible treatment option for neovascularization on cornea.8-13 One study carried out on animals, showed that, when bevacizumab was injected systemically in animals having vascularized corneas before doing keratoplasty, it resulted in improved survival of corneal graft.4 After these studies it can be assumed that bevacizumab when used either topically or subconunctivally might result in increasing the survival of the corneal graft after keratoplastyby inhibiting the vascularization on the grafted cornea. Considering these E-7010 facts, we wanted to assess the effectiveness of bevacizubamin reducing the neovascularization thus resulting in better prognosis after high risk. We used a quantitave method of assessing the corneal neovascularization on grafted cornea after keratoplasty by measuring the invasion area of neovessels. METHODOLOGY This study was an interventional/randomized, controlled, parallel group study which was carried out from February 2008 to April 2012 (51 months) at Isra Postgraduate Institute of Ophthalmology and Yasin attention hospital, Karachi. Individuals were recruited relating to inclusion criteria for the study from February 2008 to September 2011; all the individuals were adopted up for 6 months after the process. Eyes with E-7010 high risk corneal transplantation with corneal neovascularization were included in this randomized medical trial using probability purposive sampling. Sample size was not determined but was dependent on the event of the individuals appearing in the hospital with inclusion and exclusion criteria. Ethical authorization was taken from the honest committee of Isra Postgraduate Institute of Ophthalmology. Educated written consent was taken from every individual included in the study. Indications for PKP were: vascularized leucomas after herpetic keratitis, traumatic keratitis or chemical burn, advanced pseudophakic bullous keratopathy with superficial and deep corneal vascularization, severe illness in hereditary corneal dystrophy, and failed corneal grafts. Individuals were randomly allocated to 2 organizations. Group A and Group B. After penetrating keratoplasty, group A individuals received topical bevacizumab (2.5%, 25 mg/ml) which was self-administered 4 times each day for 24 week while group B patients received E-7010 only sham eye drops. Group B was the control E-7010 group. Neither subjects nor investigators were masked, but those who tested visual acuity, optometrists and statistical analysers were masked as regards treatment task of the eyes. Before undergoing process baseline data was recorded inside a proforma. Follow-up period was 2 to 8?weeks (mean 7.1?weeks). In order to reduce effect modifiers, during this period all the individuals were exposed to related topical and systemic medications such as systemic steroids and topical steroids according to the excess weight adjustments. Patients were asked to follow up every 4 weeks from the 1st postoperative day time. On every follow up digital corneal picture was taken along with the visual acuity. Patients not keeping up with follow ups were excluded from the study in order to exclude the possible confounding variables. The primary outcome variable was corneal neovascular invasion area while secondary variable was modify in visual acuity. In order to do the assessment of neovessels within the Fgfr2 grafted cornea, a quantitave method is used. We 1st took the picture of the corneas after keratoplasty and then we processed these photographs using different software such as Photoshop and MatLab. By using these software we recognized the neovessels within the grafted corneas and measured the area covered by the neovessels within the grafted corneal. E-7010 This neovascularised area is determined as percentage of grafted cornea covered by neoveseles. Data analyses were carried out using SPSS version 19. Frequencies of age gender and organizations were measured. Primary variable, neovascular invasion area, was compared between the 3 organizations using combined t test. While secondary variable, change in visual acuity, was also compared between the organizations using combined t test. P.