Aganirsen as a Therapeutic Alternative for Modulating Corneal Neovascularization: A Real-World Case Series Study

To assess the clinical benefits of aganirsen, an antisense oligonucleotide targeting insulin receptor substrate-1 (IRS-1), for reducing corneal neovascularization (CoNV) in patients scheduled for corneal transplantation.

Retrospective cohort study of patients who were treated with 1 drop of aganirsen (0.86 mg/mL) twice daily during 1 week preoperatively and at least 3 months after surgery. Changes in neovascularization were assessed qualitatively on slit-lamp examination.

The study population included 65 patients (males 61.5%), with a mean age of 60.3 years. Bilateral CoNV was observed in 1 patient only (1.5%). Main diagnoses included corneal dystrophy in 61.5% of patients, transplant rejection in 10.8%, herpes simplex keratitis and leucoma in 7.7% each, and mechanical trauma in 3.1%. A reduction of neovascularization was observed in all eyes (100%) after 3 months of treatment. Results were not influenced by demographic characteristics or diagnosis. Treatment with aganirsen made graft surgery unnecessary in 3 out of 65 patients (4.6%). Failure of corneal transplantation occurred in 5 out of 62 patients (8.1%). Diagnosis at presentation in these 5 patients were corneal dystrophy in 2, previous transplant rejection in 2, and herpetic keratouveitis in 1. Some patients presented minor conjunctival hyperemia, and 1 patient reported pruritus and discontinued the study at 2 months of treatment.

This real-world study of the use of aganirsen months starting 1 week before graft surgery adds evidence of the clinical benefits of this agent in modulating neovascularization. Standardizing and extending the duration of treatment with aganirsen may further optimize the outcome of corneal transplantation.