RESUMO
PURPOSE: The aim of this study is to describe novel therapeutic concepts to promote graft survival in high-risk keratoplasty by targeting (lymph)angiogenesis in the transplant context. METHODS: A PubMed literature search and our own clinical and experimental data are evaluated. RESULTS: There are three options for anti(lymph)angiogenic preconditioning: a) primary prevention of neovascularisation during the disease process, b) secondary prevention by regressing established blood vessels prior to transplantation and (c) tertiary prevention through inhibition of post-keratoplasty neovascularisation. CONCLUSION: Modern topical anti(lymph)angiogenic therapies seem to be able to reduce the risk of graft rejection especially in high-risk keratoplasty.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/prevenção & controle , Transplante de Córnea/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Linfangiogênese/efeitos dos fármacos , Rejeição de Enxerto/etiologia , Humanos , Pré-Medicação/métodos , Resultado do TratamentoRESUMO
There are numerous indications for local antiangiogenic therapy at the ocular surface. These include vision-limiting corneal neovascularization, corneal blood and lymphatic vessels endangering corneal graft survival and tumor-associated lymphangiogenesis. A literature review in PubMed and own clinical and experimental data form the basis for a discussion of the indications, current therapeutic options and potential side-effects of local antiangiogenic therapy at the ocular surface.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Túnica Conjuntiva/irrigação sanguínea , Neoplasias da Túnica Conjuntiva/tratamento farmacológico , Neovascularização da Córnea/tratamento farmacológico , Glaucoma de Ângulo Fechado/cirurgia , Melanoma/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Pterígio/tratamento farmacológico , Acuidade Visual/efeitos dos fármacos , Inibidores da Angiogênese/efeitos adversos , Túnica Conjuntiva/efeitos dos fármacos , Neovascularização da Córnea/etiologia , Transplante de Córnea , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Linfangiogênese/efeitos dos fármacos , Metástase Linfática/prevenção & controleRESUMO
BACKGROUND: The efficacy and safety of novel topical inhibitors of corneal neovascularisation will be discussed. METHODS: A literature review after a PUBMED search and own clinical and experimental results are presented. RESULTS: The off-label use of Avastin eye drops and GS101 eye drops against insulin receptor substrate (IRS)-1, which have been tested in phase II trial, both seem to be relatively efficient and safe ways to inhibit progressive corneal neovascularisation. Other VEGF antagonists, such as ranibizumab and pegaptanib eye drops also inhibit corneal neovascularisation. CONCLUSIONS: Avastin and GS101 eye drops are the first specific angiogenesis inhibitors for topical inhibition of corneal angiogenesis available for clinical use.