Abstract
Purpose :
Corneal neovascularization (CNV) causes decreased vision and is an important risk factor for graft rejection after (high-risk) keratoplasty (KP). Corneal crosslinking (CXL) and fine needle diathermy (FND) have previously been demonstrated to regress pathological CNV in both experimental and clinical studies. However, the impact of a combination of both treatment modalities on CNV has not been studied before. This pilot evaluation aimed to investigate whether combined CXL and FND are safe and efficient for regression of pathological CNV and corneal stabilization prior to high-risk KP.
Methods :
This retrospective case series included ten patients (7 male, 3 female, mean age 58.1 years) with CNV and the need for high-risk penetrating KP. Patients were treated with CXL and FND followed directly by penetrating KP. Corneal vessel-covered areas were measured on pre- and postoperative slit-lamp images via a semi-automatic morphometric method. Patients were followed up for adverse events and graft rejection.
Results :
Mean follow-up was 21.2 ± 7.8 weeks (range 4–31 weeks). No intraoperative complications were observed. In 4 eyes, wound leakage was observed during the early postoperative period. One of these patients required repeat-KP due to fungal keratitis, while two patients received amniotic membrane transplantation during the follow-up. One of these two patients developed endophthalmitis. Recovery of graft transparency was delayed in two eyes, and neurotrophic ulceration was observed in one graft. Combination treatment with CXL and FND resulted in a significant reduction of vascularized areas (mean reduction of 66.2%, ± 22.0%). Revascularization was not observed. All transplanted corneas remained clear and without immune reactions (except the one with fungal keratitis needing re-KP).
Conclusions :
Combined CXL and FND prior to high-risk KP seems to be an efficient method to regress pathological CNV in this pilot evaluation. Leakage from corneal incision sites may be an early postoperative risk, possibly due to delayed corneal healing. Longer follow-up of the patients and future prospective studies are required to assess the impact of CXL and FND on long-term graft survival after high-risk KP and the potential of combined CXL and FND as a novel angioregressive method.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.