Neovascularization, Corneal, CL-related Follow-up

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

Further Inpatient Care

  • Patients are treated on an outpatient basis. In extreme circumstances, where compliance, secondary infection, or impending perforation exists, a brief hospital stay may be indicated.
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Further Outpatient Care

  • Monitor CL patients with corneal NV more frequently than nonpathological healthy CL wearers,[29] perhaps using clinical photography.
  • Provide CL evaluations at 3- to 4-month intervals in the absence of symptoms; the ophthalmic clinician can address promptly any growth of vessels by modifying or discontinuing CL use (or changes in CL fit and optics).
  • Reexamine patients on topical steroids more frequently, especially to monitor their intraocular pressure.
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Inpatient & Outpatient Medications

  • Monitor patients using topical steroids every few weeks to check the intraocular pressures and evaluate the corneal NV.
  • As the NV improves, the steroids can be tapered slowly and CL wear can be resumed on a limited basis.
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Deterrence/Prevention

  • Steps that can be taken to avoid corneal NV include avoiding overnight (extended) wear and CL fits that have poor edges or are too tight, while maximizing the oxygen permeability of CLs and the appropriate use of lubricating drops while the CLs are on the eyes.
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Complications

  • New blood vessels are known to be leaky and occasionally deposit opaque material (eg, lipids, cholesterol) in the normally transparent cornea.[25] If the vessels extend to the point where such deposits occur in the visual axis, they can compromise vision.
    • These lipid deposits can resolve when the neovascularization disappears; however, this process can take weeks to months, and the lipid may never disappear.
    • Visual compromise due to deposits from corneal neovascularization occasionally requires corneal transplantation as treatment.
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Prognosis

  • The prognosis for eyes with 1-2 mm of peripheral superficial corneal NV is very good. The prognosis for eyes with a significant degree (eg, 2-4 mm) of deep corneal NV is fairly good if treated appropriately. The prognosis for eyes with greater than 4 mm of deep stromal vessels, especially if there is significant lipid deposition, is guarded.
  • The success rate for corneal transplants in eyes with significant deep corneal NV is decreased because of the increased risk of graft rejection.
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Patient Education

  • Because this is a silent disease, at least until the vessels compromise central vision, educate patients about the following:
    • Existence of CL-induced corneal NV
    • Course of corneal NV
    • Probable causes of corneal NV
    • Necessary treatment to minimize visual loss
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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.

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