Angiographic-Guided Treatment of Corneal Neovascularization

Corneal Angiogenesis: Etiologies, Complications, and Management

“…The treatment for corneal neovascularization aims at the occlusion of aferent corneal blood vessels to reduce exudative lipid keratopathy, and stromal edema and inlammation or as a preoperative conditioning intervention before keratoplasty to increase chances of graft survival [17,43]. Current treatments for corneal neovascularization consist of topical nonsteroid anti-inlammatory and corticosteroid medications [44], photodynamic therapy [45], laser photocoagulation [46,47], ine needle diathermy [48], and limbal, conjunctival, and amniotic membrane transplantation (AMT) [49].…”

Method for Angiographically Guided Fine-Needle Diathermy in the Treatment of Corneal Neovascularization

“…An HRA2 Scanning Laser Ophthalmoscope (Heidelberg Engineering, Heidelberg, Germany) with a 20°imaging lens set at 34 diopters is used for indocyanine green angiography (ICGA) and fluorescein angiography as previously described. 13,14 It is important to note that in the healthy state, the vasculature surrounding the peripheral cornea and limbus fills in a distinctive pattern with the inferior (I) quadrant filling first, followed by the superior (S), nasal (N), and finally temporal (T) quadrants (the ISNT rule). 13 In addition, the age and cardiovascular status are important considerations in determining the time elapsed before commencement of the video recording for the appearance of dye in the afferent vessels.…”

“…13,14 It is important to note that in the healthy state, the vasculature surrounding the peripheral cornea and limbus fills in a distinctive pattern with the inferior (I) quadrant filling first, followed by the superior (S), nasal (N), and finally temporal (T) quadrants (the ISNT rule). 13 In addition, the age and cardiovascular status are important considerations in determining the time elapsed before commencement of the video recording for the appearance of dye in the afferent vessels. In a young person, dye would be expected to be seen approximately 10 seconds after injection, whereas in an elderly person the dye may not appear until after 25 seconds.…”

Corneal Angiography for Guiding and Evaluating Fine-Needle Diathermy Treatment of Corneal Neovascularization

“…Therefore, one option is to treat only the afferent vessel(s) of the CoNV. 12 Although it is sometimes possible to distinguish afferent from efferent CoNV using slit-lamp biomicroscopy, it has been shown that the full extent and origin of the CoNV complex is not apparent on color images. 13e15 However, we have recently shown that corneal angiography (fluorescein angiography [FA] and indocyanine green angiography [ICGA]) are particularly useful in identifying vessels not seen on color images, 13e15 especially in the presence of corneal scars or inflammation, and facilitate identification and differentiation of afferent and efferent vessels and vessel leakage.…”