Therapeutic approaches for corneal neovascularization

Abstract

Angiogenesis refers to new blood vessels that originate from pre-existing vascular structures. Corneal neovascularization which can lead to compromised visual acuity occurs in a wide variety of corneal pathologies. A large subset of measures has been advocated to prevent and/or treat corneal neovascularization with varying degrees of success. These approaches include topical corticosteroid administration, laser treatment, cautery, and fine needle diathermy. Since the imbalance between proangiogenic agents and antiangiogenic agents primarily mediate the process of corneal neovascularization, recent therapies are intended to disrupt the different steps in the synthesis and actions of proangiogenic factors. These approaches, however, are only partially effective and may lead to several side effects. The aim of this article is to review the most relevant treatments for corneal neovascularization available so far.

MMP-9 Downregulation with Lipid Nanoparticles for Inhibiting Corneal Neovascularization by Gene Silencing

“…Among the enzymes included in this group, MMP-9 is one of the primary extracellular matrix remodeling enzymes that participate in pathological conditions of the cornea, including corneal neovascularization (CNV) [6]. Although neovascularization is part of the repair process of extensive damage to the eye surface [7], it can lead to compromised visual acuity because the cornea loses its avascularity feature. Current treatment options for CNV include the topical application of nonsteroidal or corticosteroidal anti-inflammatory agents, immunosuppressive drugs or surgical interventions such as photodynamic therapy cauterization and β-irradiations [8].…”

Management of Neovascularization in Recurrent Herpetic Keratitis

“…To this, we added acyclovir so as to manage the source of this complication and provide protection against inactivation of the virus. 12 The American Academy of Ophthalmology has also suggested that patients must be followed up for ocular examination regardless of the symptoms, at 1, 3, 6, 9 and 12 months post management, the reason being that if the patient showed repeated reactivation of epithelial disease during his follow up, then corneal collagen cross-linking with riboflavin and ultraviolet-A could be considered. 13 In addition, a prophylactic dose of ganciclovir gel, in combination with topical ganciclovir has been postulated to be helpful in the treatment of herpetic stromal keratitis.…”

Adeno-Associated Virus Mediated Gene Therapy for Corneal Diseases

“…Currently drugs used to control corneal neovascularization include anti-inflammatory drugs (topical steroids and/or NSAIDs), anti-VEGF agents (topical and/or subconjunctival administration of bevacizumab or ranibizumab), and/or MMP inhibitors (oral doxorubicin combined with topical corticosteroids), while surgical options include laser photocoagulation. These treatments often display partial efficacy and may result in additional ocular complications [ 124 ]. Therefore, gene therapy-mediated treatments against corneal neovascularization may be beneficial in patients.…”