Neovascularization, Corneal, CL-related Clinical Presentation

  • Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jul 13, 2011
 

History

  • Patients are almost always asymptomatic unless the central visual axis is involved.
  • Patients with CL-induced NV are often aphakic or report a history of sleeping or napping with their CLs on their eyes in an extended wear modality.
  • Often, a history of poor compliance with proper CL wear (eg, wear extended intentionally or unintentionally through multiple sleep cycles) and care is present. Alternatively, the CLs may be "tight" (eg, restrict tear exchange).
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Physical

  • NV can be observed in the cornea via slit lamp biomicroscopy. It can be seen in direct illumination or in retroillumination as a continuum of the limbal peripheral vessel arcades. Measuring both the extent and the depth of the corneal NV is important.
    • Superficial vessels emerge in the anterior stroma and appear as single or multiple (pannus) tortuous vessels under low magnification.
    • Deeper stromal vessels emerge through the cornea as straight vessels that arborize, occasionally accompanied by nerve fibers.
    • Active engorged vessels, occasionally surrounded by lipid exudates and exceeding 1-2 millimeters in length from the limbus, should raise concern.
    • Lipid deposition appears as yellow-white opacities at the leading edge or surrounding the stromal vessels.
    • Careful gonioscopy in eyes with deep NV rules out an iris angle choroidal tumor.
    • NV also should be differentiated at clinical examination from a conjunctival carcinoma extending onto the corneal epithelium.
  • Measurement of corneal sensation can be helpful in differentiating CL-related NV from a herpes simplex virus (HSV) keratitis (typically reduced sensation with HSV).
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Causes

  • All CLs, including extended-wear hydrogel, daily-wear hydrogel, hard, and rigid gas permeable CLs, can cause corneal NV. NV primarily is related to corneal hypoxia from CL wear and/or chronic corneal desiccation associated with the edges or rigid lenses.
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Contributor Information and Disclosures
Author

Barry A Weissman, OD, PhD, FAAO  Chief of Contact Lens Service, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine; Adjunct Professor of Optometry, Southern California College of Optometry

Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association, California Optometric Society, and International Society for Contact Lens Research

Disclosure: VSP None Speaking and teaching; Alcon None Speaking and teaching; Vistakon/The Vision Care Institute Grant/research funds support of Fellowship program

Coauthor(s)

Karen K Yeung, OD, FAAO  Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California at Los Angeles

Karen K Yeung, OD, FAAO is a member of the following medical societies: American Academy of Optometry

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew W Lawton, MD  Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Dixon JM. Corneal vascularization due to corneal contact lenses: the clinical picture. Trans Am Ophthalmol Soc. 1967;65:333-40. [Medline].

  2. Dixon JM, Lawaczec E. Corneal vascularization due to contact lenses. Arch Ophthalmol. 1963;69:106-9.

  3. Chan WK, Weissman BA. Corneal pannus associated with contact lens wear. Am J Ophthalmol. May 1996;121(5):540-6. [Medline].

  4. Cogan DG. Vascularization of the cornea. Its experimental induction by small lesions and a new theory of its pathogenesis. Arch Ophthalmol. 1949;41:406-416.

  5. Cogan DG. Corneal vascularization. Investigative Ophthalmology and Vis. 1962;(1): 2:253-61.

  6. Ashton N, Cook C. Mechanisms of corneal neovascularization. Brit J Ophthal. 1953;37:193-209.

  7. Madigan MC, Penfold PL, Holden BA, Billson FA. Ultrastructural features of contact lens-induced deep corneal neovascularization and associated stromal leukocytes. Cornea. Apr 1990;9(2):144-51. [Medline].

  8. Groden LR, Cassel GH, Laibson PR. The effect of corneal trephination on neovascularization. Ophthalmic Surg. Nov 1983;14(11):954-6. [Medline].

  9. Imre G. The role of increased lactic acid concentration in neovascularizations. Acta Morphol Hung. 1984;32(2):97-103. [Medline].

  10. Fromer CH, Klintworth GK. An evaluation of the role of leukocytes in the pathogenesis of experimentally induced corneal vascularization. Am J Pathol. Jun 1975;79(3):537-54. [Medline].

  11. Fromer CH, Klintworth GK. An evaluation of the role of leukocytes in the pathogenesis of experimentally induced corneal vascularization. III. Studies related to the vasoproliferative capability of polymorphonuclear leukocytes and lymphocytes. Am J Pathol. Jan 1976;82(1):157-70. [Medline].

  12. Koch AE, Polverini PJ, Leibovich SJ. Induction of neovascularization by activated human monocytes. J Leukoc Biol. Feb 1986;39(2):233-8. [Medline].

  13. Klintworth GK. Corneal Angiogenesis. New York: Springer-Verlag; 1991:1-30.

  14. Forister J, Forister EF, Yeung KK, Chung MY, Ye P, Tsai A, et al. Weissman BA. Prevalence of common ocular complications associated with contact lens wear: The UCLA contact lens complication study. Vis Opt Sci (In preparation).

  15. Donnenfeld ED, Ingraham H, Perry HD, Imundo M, Goldberg LP. Contact lens-related deep stromal intracorneal hemorrhage. Ophthalmology. Dec 1991;98(12):1793-6. [Medline].

  16. Filipec M, Hycl J, Kraus H. [Does vascularization and the graft diameter affect the rejection reaction in corneal transplantation?]. Cesk Oftalmol. Feb 1994;50(1):13-7. [Medline].

  17. Foulks GN, Steffanson E, Hamilton RC. Regression of corneal vascularization during silicone contact lens wear and the relationship to contact lens-induced anterior chamber hypoxia. Cornea. 1987;65:6-60.

  18. Qian CX, Bahar I, Levinger E, Rootman D. Combined use of superficial keratectomy and subconjunctival bevacizumab injection for corneal neovascularization. Cornea. Oct 2008;27(9):1090-2. [Medline].

  19. Gupta D, Illingworth C. Treatments for corneal neovascularization: a review. Cornea. Aug 2011;30(8):927-38. [Medline].

  20. Benelli U, Bocci G, Danesi R, Lepri A, Bernardini N, Bianchi F. The heparan sulfate suleparoide inhibits rat corneal angiogenesis and in vitro neovascularization. Exp Eye Res. Aug 1998;67(2):133-42. [Medline].

  21. Crum R, Szabo S, Folkman J. A new class of steroids inhibits angiogenesis in the presence of heparin or a heparin fragment. Science. Dec 20 1985;230(4732):1375-8. [Medline].

  22. Lipman RM, Epstein RJ, Hendricks RL. Suppression of corneal neovascularization with cyclosporine. Arch Ophthalmol. Mar 1992;110(3):405-7. [Medline].

  23. D'Amato RJ, Loughnan MS, Flynn E, Folkman J. Thalidomide is an inhibitor of angiogenesis. Proc Natl Acad Sci U S A. Apr 26 1994;91(9):4082-5. [Medline].

  24. Bian F, Zhang MC, Zhu Y. Inhibitory effect of curcumin on corneal neovascularization in vitro and in vivo. Ophthalmologica. 2008;222(3):178-86. [Medline].

  25. Wong AL, Weissman BA, Mondino BJ. Bilateral corneal neovascularization and opacification associated with unmonitored contact lens wear. Am J Ophthalmol. Nov 2003;136(5):957-8. [Medline].

  26. Maguire MB. Risk factors for corneal graft failure and rejection in the collaborative corneal transplantation studies. Opthal. 1974;101:1536-1547.

  27. Sawa M, Awazu K, Takahashi T, et al. Application of femtosecond ultrashort pulse laser to photodynamic therapy mediated by indocyanine green. Br J Ophthalmol. Jun 2004;88(6):826-31. [Medline].

  28. Holzer MP, Solomon KD, Vroman DT, et al. Photodynamic therapy with verteporfin in a rabbit model of corneal neovascularization. Invest Ophthalmol Vis Sci. Jul 2003;44(7):2954-8. [Medline].

  29. Caffery BE, Josephson JE. Corneal vascularization. Optom Clin. 1995;4(3):19-29. [Medline].

  30. Grohe RM, Lebow KA. Vascularized limbal keratitis. Int Contact Lens Clinics. 1989;16:197-209.

  31. Jouseen AM, Druse FE, Volcker HE, et al. Topical application of methotrexate for inhibition of corneal angiogenesis. Graefes Arch Clin Exp Ophthalmol. 1999;238:920-7.

  32. Verbey NL, van Haeringen NJ, de Jong PT. Modulation of immunogenic keratitis in rabbits by topical administration of inhibitors of liposygenase and cyclooxygenase. Curr Eye Res. 1998;7:361-8.

 
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