eMedicine Specialties > Ophthalmology > Cornea

Neovascularization, Corneal, CL-related: Follow-up

Author: Barry A Weissman, OD, PhD, FAAO, Chief of Contact Lens Service, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles
Coauthor(s): Karen K Yeung, OD, FAAO, Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California at Los Angeles
Contributor Information and Disclosures

Updated: Apr 10, 2009

Follow-up

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.

Further Outpatient Care

  • Monitor CL patients with corneal NV more frequently than nonpathological healthy CL wearers.28
  • 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.

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.

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.

Complications

  • New blood vessels are known to be leaky and occasionally deposit opaque material (eg, lipids, cholesterol) in the normally transparent cornea.24 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.

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.

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

Miscellaneous

Medicolegal Pitfalls

  • Missing the diagnosis of HSV infection and initiating treatment with topical corticosteroids may have disastrous consequences.
  • Not treating eyes with significant corneal NV, but still with good vision, risks visual loss.
 


More on Neovascularization, Corneal, CL-related

Overview: Neovascularization, Corneal, CL-related
Differential Diagnoses & Workup: Neovascularization, Corneal, CL-related
Treatment & Medication: Neovascularization, Corneal, CL-related
Follow-up: Neovascularization, Corneal, CL-related
References
[ CLOSE WINDOW ]

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. 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].

  20. 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].

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

  22. 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].

  23. 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].

  24. 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].

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

  26. 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].

  27. 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].

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

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

  30. 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.

  31. 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.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

cornea, contact lens, neovascularization, corneal trauma

[ CLOSE WINDOW ]

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 at Los Angeles
Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

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.

Medical Editor

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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman 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

CME Editor

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.