Neovascularization, Corneal, CL-related Treatment & Management

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

Medical Care

  • The primary treatment of NV is eliminating the underlying cause. Ghost vessels remain even after NV is treated.
    • For patients who wear CLs, NV can be minimized by decreasing CL wear time, discontinuing CL wear, refitting RGP CLs with improved edge designs and/or less tight (looser) fitting lenses, or refitting into higher oxygen permeable (Dk) CLs, such as high oxygen permeable (Dk) rigid gas permeable or soft silicone hydrogel lenses.
    • Since CL-induced NV is most common in patients who are highly nearsighted, have dry eyes, and use extended wear hydrogel CLs, these patients, depending on severity, should be refitted into daily wear, higher oxygen permeable silicone CLs[17] or daily wear rigid gas permeable CLs when NV is diagnosed.
    • For those patients with severe corneal NV, CL wear may be contraindicated.
    • Other coinciding injurious factors, such as acne rosacea, blepharitis, dry eye, and Staphylococcus hypersensitivity, should be addressed if present.
  • Topical corticosteroids can be used for active neovascularization. Discontinuation of CL wear is of essence during the recovery period for these patients. Corticosteroids can increase the risk of infection during CL wear.
  • More recently, topical and subconjunctival bevacizumab[18, 19] in combination with superficial keratectomy on ocular surface NV has shown promise as a new treatment option. Bevacizumab prevents the receptor binding of the soluble form of VEGF and, hence, prevents the process of the angiogenic pathway on superficial vessels. Bevacizumab, alone, is ineffective against existing blood vessels.
  • Because angiogenesis is a multistep process, many treatments in animal models are being tested to inhibit the migration, proliferation, and differentiation of endothelial cells. Some authors have discussed treatment in animal models with angiostatic steroids, heparin,[20, 21] systemic amiloride, cyclosporine A,[22] thalidomide,[23] arachidonic acid inhibitors, flurbiprofen, curcumin,[24] and systemic suppression medications (cytotoxic agents).
Next

Surgical Care

  • Severe corneal NV may result in central corneal scarring,[25] and permanent reduction in vision. In that case, and if medical management does not recover visual acuity, corneal transplantation may be indicated. Depending of the amount of neovascularization present (especially deep NV) such cornea grafts may be considered high risk.[26]
  • Investigators have treated corneal NV with photodynamic therapy[27, 28] and argon laser obliteration of the vessel lumen. This can be achieved in the corneal part of the vessels (accessible to be lasered) but usually has a short-term effect, as the vessel lumen invariably reopens. Argon laser pannus obliteration is mainly a temporizing measure.
  • Hyperbaric oxygen treatment has been used with limited success. This treatment modality aims to suppress angiogenesis by supplying the corneal tissue with redundant oxygen supply.
Previous
Proceed to Medication
 
 
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.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
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.