Regression of Recalcitrant Corneal Neovascularization and Graft Revival With Systemic Bevacizumab: A Case Report

Purpose: Corneal neovascularization is a sight-threatening pathology arising from various conditions and compromises keratoplasty survival. Treating neovascularization is critical for graft outcomes; however, both medical and surgical interventions often fail in severe cases. We report the first known case of regression of corneal neovascularisation associated with systemic bevacizumab accompanied by unexpected recovery of a previously failed Descemet Membrane Endothelial Keratoplasty (DMEK). Methods: A 64-year-old woman presented with right eye bullous keratopathy and deep stromal neovascularization after phakic intraocular lens implantation. Corneal neovascularization persisted despite phakic intraocular lens explantation, vessel cautery, and subconjunctival bevacizumab. The patient subsequently underwent combined phacoemulsification and Descemet membrane endothelial keratoplasty (DMEK), which failed secondary to graft rejection despite intensive topical steroid therapy. Further local therapies, including repeat vessel cautery and intrastromal bevacizumab, were unsuccessful. The patient was later diagnosed with ovarian cancer and treated with systemic bevacizumab, carboplatin, and paclitaxel. Results: After systemic therapy for ovarian cancer, the deep stromal vascularization markedly regressed, together with complete resolution of the corneal edema. Central corneal thickness improved from 1111 μm at rejection to 510 μm. Importantly, this represented not only vascular regression but functional recovery of a DMEK that had remained edematous for 10 months and had been considered irreversibly rejected. Visual acuity remained limited (0.8 logMAR) by residual central lipid keratopathy. Discussion: This case demonstrates significant regression of deep established corneal neovascularization in a failed DMEK after systemic bevacizumab previously refractory to local therapy and apparent revival of a previously failed DMEK. To our knowledge, this represents the first reported case of systemic bevacizumab, administered as part of a triple systemic anticancer therapy, associated with regression of advanced corneal neovascularization and recovery of corneal clarify after DMEK failure. Although causality cannot be definitively established, the temporal association suggests a potential adjunctive role for systemic anti-VEGF therapy in selected cases of refractory corneal neovascularization and possibly restore function in transplants thought to have failed irreversibly.