Treating corneal neovascularization using a combination of anti-VEGF injection and argon laser photocoagulation application - case report

Donato, Mariela Grossi; Donato, Elias; Cordeiro, Marina Álvares de Campos; Andrade, Matheus Martins de; Freitas, João Alberto Holanda de

doi:10.22336/rjo.2021.58

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Both lasers can treat efferent NV because these vessels have relatively slower blood flow but can be ineffective against thinner afferent vessels with faster blood flow [8]. Numerous case reports have reported outcomes of argon laser in combination with anti-VEGF treatment such as bevacizumab, all of which described short-term regression of corneal NV (Figure 5, Supplemental Digital Content, http://links.lww.com/COOP/A66) [11,74,75]. A study by Kumar et al examined 40 corneal NV eyes treated by Nd: YAG laser and reported a statistically significant difference in the percentage of mean NVA three months posttreatment [76].…”

Section: Laser Therapiesmentioning

confidence: 99%

Current trends in the management of corneal neovascularization

Rangu,

Dang,

Riaz

2024

Current Opinion in Ophthalmology

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Purpose of review The aim of this study was to highlight recent developments in the medical and surgical management of corneal neovascularization (NV). Recent findings Improved understanding and diagnostic criteria among clinicians have led to advancements in the characterization of corneal NV and objective assessment of treatment response through ancillary imaging devices. Developments in corneal NV treatments, such as antivascular endothelial growth factor, fine needle diathermy, and photodynamic therapy, have improved treatment success rates and visual outcomes. More recent surgical treatment advancements include corneal cross-linking, endothelial keratoplasty, and mitomycin intravascular chemoembolization. Finally, a greater appreciation of the molecular pathogenesis and angiogenic factors involved in corneal NV has identified numerous potential targeted therapies in the future. Summary The management of corneal NV has evolved to include several standalone and combination medical and surgical options. Additionally, improvements in quantifying corneal NV and understanding its molecular basis have contributed to new management strategies with improved outcomes.

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Section: Laser Therapiesmentioning

confidence: 99%

Current trends in the management of corneal neovascularization

Rangu,

Dang,

Riaz

2024

Current Opinion in Ophthalmology

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“…Contrastingly, it is difficult to obliterate afferent vessels as they are thinner, more deeply located in the cornea, and characterized by a rapid blood flow. In this case, laser therapy is ineffective, and thermal damage due to repeated use might promote neovascularization recurrence [168,169]. The complications of laser therapy can include corneal endothelial damage, corneal thinning, intraocular hemorrhage, pupillary displacement, iris atrophy, and corneal suture lysis after corneal transplantation [2].…”

Section: Laser Therapymentioning

confidence: 99%

Available Therapeutic Options for Corneal Neovascularization: A Review

Drzyzga,

Śpiewak,

Dorecka

et al. 2024

IJMS

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Corneal neovascularization can impair vision and result in a poor quality of life. The pathogenesis involves a complex interplay of angiogenic factors, notably vascular endothelial growth factor (VEGF). This review provides a comprehensive overview of potential therapies for corneal neovascularization, covering tissue inhibitors of metalloproteinases (TIMPs), transforming growth factor beta (TGF-β) inhibitors, interleukin-1L receptor antagonist (IL-1 Ra), nitric oxide synthase (NOS) isoforms, galectin-3 inhibitors, retinal pigment epithelium-derived factor (PEDF), platelet-derived growth factor (PDGF) receptor inhibitors, and surgical treatments. Conventional treatments include anti-VEGF therapy and laser interventions, while emerging therapies such as immunosuppressive drugs (cyclosporine and rapamycin) have been explored. Losartan and decorin are potential antifibrotic agents that mitigate TGF-β-induced fibrosis. Ocular nanosystems are innovative drug-delivery platforms that facilitate the targeted release of therapeutic agents. Gene therapies, such as small interfering RNA and antisense oligonucleotides, are promising approaches for selectively inhibiting angiogenesis-related gene expression. Aganirsen is efficacious in reducing the corneal neovascularization area without significant adverse effects. These multifaceted approaches underscore the corneal neovascularization management complexity and highlight ideas for enhancing therapeutic outcomes. Furthermore, the importance of combination therapies and the need for further research to develop specific inhibitors while considering their therapeutic efficacy and potential adverse effects are discussed.

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“…In contrast, it is difficult to obliterate afferent vessels because they are thinner and more deeply located in the cornea and are characterized by rapid blood flow. In their case, laser therapy is ineffective, and when repeated, thermal damage may promote the recurrence of neovascularization [62,63].Complications of laser therapy can include corneal endothelial damage, corneal thinning, intraocular hemorrhage, pupillary displacement, iris atrophy, and corneal suture lysis after corneal transplantation [2].…”

Section: Laser Therapymentioning

confidence: 99%

Update on Therapeutic Approaches to Corneal Neovascularisation

Drzyzga,

Śpiewak,

Wyględowska-Promieńska

2023

Preprint

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A healthy cornea is a nonvascularized, transparent tissue. It is nourished by diffusion through the tear film, aqueous fluid and neurotrophins supplied by the corneal innervation. The cornea is devoid of both blood and lymphatic vessels, which makes it an immunologi-cally privileged tissue. Corneal neovascularization develops due to an imbalance between angiogenic and anti-angiogenic factors and can lead to a significant decrease in visual acui-ty. It may cause scarring, lipid keratopathy, and corneal edema. The resulting pathological vascularization of the cornea reduces its immune privilege and significantly worsens the prognosis after subsequent penetrating keratoplasty, increasing the risk of rejection of the transplanted flap. Neovascularization is favored by many disease processes, including auto-immune diseases, viral inflammations, mainly herpes and varicella-zoster, and blepharitis [1]. There are several options to treat corneal neovascularization, both pharmacological and surgical. Angiostatic treatment involves inhibiting the growth of new vessels by suppressing inflammatory responses. VEGF inhibitors, steroids, cyclosporine A, and amniotic membrane grafts secured to the cornea work this way. VEGF inhibitors are the agents with the direct and most potent angiostatic effect. Angioregressive treatment, on the other hand, results in the regression of already existing pathological vessels. This therapy is also based on VEGF inhibitors, which, however, have the most potent effect on newly formed and small vessels but are less effective in reducing large-caliber and mature vessels. A more effective method for such vessels is ablation, which involves surgical closure. The most commonly used an-gio-occlusive method is needle diathermy and argon or yellow laser therapy. In advanced corneal neovascularization, corneal transplant surgery may be necessary. It is best performed after pretreatment with anti-VEGF preparations, often continued after corneal transplanta-tion to reduce the risk of transplant rejection [2]. This paper discusses the pathogenesis of corneal neovascularization and the current and future trends in its treatment.

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Treating corneal neovascularization using a combination of anti-VEGF injection and argon laser photocoagulation application - case report

Abstract: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cited by 4 publications

References 8 publications

Current trends in the management of corneal neovascularization

Current trends in the management of corneal neovascularization

Available Therapeutic Options for Corneal Neovascularization: A Review

Update on Therapeutic Approaches to Corneal Neovascularisation

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