Response to antiangiogenic treatment with mitomycin-C in corneal neovascularization

Abstract

Purpose : Maintaining transparency and avascularity is essential to preserve optimal vision. The administration of mitomycin-C (MMC) has been used intravenously for a hypoxic and embolic effect. This study aims to describe clinical outcomes of intravascular MMC for the treatment of corneal neovascularization.

Methods : A pilot study of 8 eyes with corneal neovascularization injection 0.1ml of MMC. Quantification of neovascularization was measured by an independent observer. ImageJ software (NIH, Bethesda Maryland) was used to trace and quantify vasculature in standardized clinical slitlamp photographs. Briefly all identifiable vessels were drawn upon and the number of pixels quantified. Each image was measured 3 times. Follow-up was done at 1 week, 1 month and 2 months post-injection. Preop and postop values were compared using t-test and statically significant value was set at p < 0.5.

Results : A total of 8 subjects were enrolled, of which 37.5% were female with an age range of 17-64 years (average of 37 years). In 62.5% of the cases the left eye was affected. The most frequent etiology responsible for the corneal vascularization was history of herpetic keratitis in 75% of the subject, phlyctenular keratoconjunctivis in 12.5%, and neovascularization secondary to intrastromal rings in 12.5%. One subject 12.5% presented herpes keratitis reactivation 7 days after injection, despite being on oral antiviral suppression therapy. Mean preoperative UDVA was 1.01 (+ 0.42), CDVA was 0.76 (+0.53) LogMAR. Postoperative UDVA was 0.91 (+0.42) and CDVA was 0.63 (+0.42) LogMAR with no statistically significant differences when preop and postop values were compared p>0.05. Two patients improved both UDVA and CDVA. Comparing photographs, there was an overall reduction of 60.27% of pixels in corneal vascularization at the las follow-up.

Conclusions : Corneal intrastromal MMC may be a potential therapeutic strategy to treat corneal neovascularization. Here we present short term results demonstrating that neovascularization may be reduced with clinically significant results, thus rendering this patients more suitable for optical surgical procedures. Despite regression of neovascularization visual acuity may not improve particularly if stroma is scarred. Further studies are needed to address its safety and long-term effects.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.