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Natasha Spiteri, Jern Chen, Yalin Zheng, Vito Romano, Adrian Tey, Sohraab Yadav, Sajjad Ahmad, Stephen Kaye; Corneal angiography for assessing, guiding and evaluating treatment of corneal neovascularisation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3247.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the role of indocyanine green (ICGA) and fluorescein angiography (FA) in the treatment of corneal neovascularisation (CoNV).
Prospective interventional case series of patients with CoNV secondary to varying corneal pathology. Patients underwent FA and ICGA to identify the extent of CoNV and to identify the afferent corneal vessels. Fine needle diathermy (FND) was applied to the afferent stems of CoNV. Pre- and post-treatment FA and ICGA images were analysed for perfused vessel calibre and area.
24 patients with CoNV underwent FND. The afferent vessels were identified in all cases using ICGA. The ratio of afferent to efferent vessels varied between 1:5 to 1:10. Afferent vessels had smaller mean diameters (38.6μm) compared to efferent vessels (59.9μm), were most easily identified distal or adjacent to the limbus and were located deeper than efferent vessels. FA was particularly useful for grading the maturity of the CoNV. The mean area of CoNV following first treatment, reduced from 2.01mm2 pre-operatively (SD = 1.51) to 1.18mm2 post-operatively (SD = 1.39), with a mean reduction in area of 0.83mm2 (SD = 0.80). Five patients required re-treatment with FND due to the presence of perfused CoNV evident on FA and ICGA, but not visible on colour images. Repeat FA and ICGA following re-treatment confirmed successful closure of the persistent CoNV. Adverse reactions to FND included intrastromal haemorrhage (1) and increased corneal astigmatism (2), which resolved spontaneously.
Corneal neovascularisation (CoNV) is associated with significant visual morbidity. Angiography offers the ability to guide the treatment of CoNV with selective treatment to afferent components of the vascular complex. This minimises the amount of diathermy needed, thereby reducing the risks of this treatment. Corneal angiography is also very useful for detecting CoNV, many of which are not evident on colour images and is therefore, essential in evaluating the outcome following any proposed treatment for CoNV.
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