Neovascularization, Corneal, CL-related Follow-up

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

Further Outpatient Care

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  • Monitor CL patients with corneal NV more frequently than nonpathological healthy CL wearers, [39] 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 using topical steroids more frequently, especially to monitor their intraocular pressure.

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Further Inpatient Care

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  • 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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Inpatient & Outpatient Medications

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  • 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 after termination of the steroid use.

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Deterrence/Prevention

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  • 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

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  • New blood vessels are known to be leaky and occasionally deposit opaque material (eg, lipids, cholesterol) in the normally transparent cornea. [34] 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

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  • 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

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  • 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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