Abstract
Purpose :
Corneal neovascularization (CoNV) reduces visual acuity and increases the risk of graft rejection after (high-risk) keratoplasty (PK). Both fine needle diathermy (FND) and corneal crosslinking (CXL) have been shown to regress pathological CoNV in both experimental and early clinical studies individually. The aim of this retrospective pilot evaluation was to analyze whether FND and CXL are safe and effective in stabilising recipient cornea, regressing CoNV and improving graft survival when combined with high-risk PK.
Methods :
Seven patients (4 male, 3 female, mean age 57.1 years) with CoNV and the need for high-risk PK were included in this retrospective study. Patients first underwent FND, followed by PK, and lastly peripheral CXL with limbal protection shield in the same session. Pre- and postoperative slit-lamp images were analyzed morphometrically for areas of CoNV. Patients were followed up for adverse events and graft rejection.
Results :
Mean follow-up was 50.6 ± 38.1 weeks (range 3–96 weeks). No intraoperative complications were observed. In three eyes, delayed epithelization of the cornea was observed during the early postoperative period. Two of these patients received amniotic membrane transplantation, one of these patients required repeat-keratoplasty due to a neurotrophic ulcer. Another eye developed phthisis after other non-corneal intraocular surgeries. Recovery of graft transparency was delayed in one eye. The combined approach led to a significant reduction of CoNV (mean reduction of 75.1%, ± 14.0) excluding the graft area. Revascularization was not observed during follow-up. One non-compliant patient presented with corneal decompensation 21 months after the surgery. The remaining transplanted corneas were clear and without immune reactions during the follow-up.
Conclusions :
This retrospective analysis of combined treatment appears to be an effective method to regress CoNV. Corneal epithelization might be slowed in some cases in the early postoperative period, therefore close monitoring is advisable. Separation of angioregressive treatment from high-PK might offer a safer approach. Prospective studies with larger patient cohorts are needed to evaluate the influence of CXL and FND on long-term graft survival after high-risk PK.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.