Medscape is available in 5 Language Editions – Choose your Edition here.


Neovascularization, Corneal, CL-related Treatment & Management

  • Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Aug 19, 2015

Medical Care

The primary treatment of NV is eliminating the underlying cause. Ghost vessels remain even after NV is treated. Details are as follows:

  • For patients who wear CLs, NV can be minimized by decreasing CL wear time, discontinuing extended or all 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 [23] 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, as well as glaucoma and cataracts.

More recently, topical and subconjunctival bevacizumab[24, 25, 26, 27] 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 and is most effective in earlier than later stages of NV.[28]

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,[29, 30] systemic amiloride, cyclosporine A,[31] thalidomide,[32] arachidonic acid inhibitors, flurbiprofen, curcumin,[33] and systemic suppression medications (cytotoxic agents).


Surgical Care

Severe corneal NV may result in central corneal scarring,[34] 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.[35]

Investigators have treated corneal NV with photodynamic therapy[36, 37, 38] 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.

Amniotic membrane transplantation regenerates the ocular surface and thereby prevents neovascularization.

Contributor Information and Disclosures

Barry A Weissman, OD, PhD, FAAO Professor of Optometry, Southern California College of Optometry; Professor Emeritus of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.


Karen K Yeung, OD, FAAO Senior Optometrist, Arthur Ashe Student Health and Wellness Center, University of California, 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

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

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

Disclosure: Nothing to disclose.

  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. Papas EB. The role of hypoxia in the limbal vascular response to soft contact lens wear. Eye Contact Lens. 2003 Jan. 29 (1 Suppl):S72-4; discussion S83-4, S192-4. [Medline].

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

  5. 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.

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

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

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

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

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

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

  12. 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. 1976 Jan. 82(1):157-70. [Medline].

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

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

  15. Brennan NA, Coles ML, Comstock TL, Levy B. A 1-year prospective clinical trial of balafilcon a (PureVision) silicone-hydrogel contact lenses used on a 30-day continuous wear schedule. Ophthalmology. 2002 Jun. 109 (6):1172-7. [Medline].

  16. Sweeney DF. Have silicone hydrogel lenses eliminated hypoxia?. Eye Contact Lens. 2013 Jan. 39(1):53-60. [Medline].

  17. 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).

  18. Lee SY, Kim YH, Johnson D, Mondino BJ, Weissman BA. Contact lens complications in an urgent-care population: the University of California, Los Angeles, contact lens study. Eye Contact Lens. 2012 Jan. 38 (1):49-52. [Medline].

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

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

  21. Faraj LA, Said DG, Al-Aqaba M, Otri AM, Dua HS. Clinical evaluation and characterisation of corneal vascularisation. Br J Ophthalmol. 2015 Jul 10. 1-8. [Medline].

  22. Abdelfattah NS, Amgad M, Zayed AA, Salem H, Elkhanany AE, Hussein H, et al. Clinical correlates of common corneal neovascular diseases: a literature review. Int J Ophthalmol. 2015. 8 (1):182-93. [Medline].

  23. 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.

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

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

  26. Zaki AA, Farid SF. Subconjunctival bevacizumab for corneal neovascularization. Acta Ophthalmol. 2010 Dec. 88(8):868-71. [Medline].

  27. Chang JH, Garg NK, Lunde E, Han KY, Jain S, Azar DT. Corneal neovascularization: an anti-VEGF therapy review. Surv Ophthalmol. 2012 Sep. 57 (5):415-29. [Medline].

  28. Chen WL, Chen YM, Chu HS, Lin CT, Chow LP, Chen CT, et al. Mechanisms controlling the effects of bevacizumab (avastin) on the inhibition of early but not late formed corneal neovascularization. PLoS One. 2014. 9 (4):e94205. [Medline].

  29. 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. 1998 Aug. 67(2):133-42. [Medline].

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

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

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

  33. 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].

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

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

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

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

  38. Sugisaki K, Usui T, Nishiyama N, Jang WD, Yanagi Y, Yamagami S, et al. Photodynamic therapy for corneal neovascularization using polymeric micelles encapsulating dendrimer porphyrins. Invest Ophthalmol Vis Sci. 2008 Mar. 49 (3):894-9. [Medline].

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

  40. Chen P, Yin H, Wang Y, Wang Y, Xie L. Inhibition of VEGF expression and corneal neovascularization by shRNA targeting HIF-1a in a mouse model of closed eye contact lens wear. Mol Vis. 2012. 18:864-73. [Medline].

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

  42. 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.

  43. 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.

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.