Is There The Best Technique For The Treatment Of Corneal Neovascularization ?

The cornea is a tissue maintained avascular due to a balance between the anti-angiogenic factors expressed at its level and the repression of pro-angiogenic factors. This equilibrium can be disturbed during  corneal aggression leading to a hyper-expression of pro-angiogenic factors that result in the formation of corneal vessels in the corneal  . The purpose of the study is to evaluate and compare the efficacy of a subconjunctival injection of Bevacizumab and fine needle diathermy (FND) and their combination on reducing corneal neovascularization

It was a comparative study in the ophthalmology department of the university hospital center of Casablanca  . The study lasted two years. Seventy five patients were included in this study, all of whom had corneal vessels on a stromal scar following a treated corneal abscess that we decided to take in order to prepare them for a possible corneal transplant. Patients with associated ocular conditions  were excluded from the study.

For the treatment of these corneal vessels, patients were randomly divided into three groups of 25 patients: the first group (group A) was treated by a fine needle diathermy, the second (group B) received 7 subconjunctival injections of Bevacizumab  , and for the third group (group C) we used a combination of the two treatments.

Injections were made under topical anesthesia . This technique was performed under peribulbar anesthesia Bupivacain+ Lidocain.   Patients were examined the day after the procedure, 7 years later then monthly. Parameters studied were: Visual acuity, vascularized corneal surface and maximal regression of vessels judged and tolerance to the different therapeutics used. 

 

 

Seventy five  eyes of seventy five  patients were included, they were 24 males and 36 females. The average age was 36 years old (range: 24-75). The best corrected initial visual acuity of our patients 48 patients (65%) had neovascularization of the two upper quadrants of the cornea, 32 of them had superficial corneal vessels . For the group B who received subconjunctival injections of Bevacizumab, Patients received five injections and we noted a maximal regression of the vessels in 10 patients and  7 patients had as a complication a subconjunctival hemorrhage which disappeared over all after one week.  

 

Many therapeutic modalities reduce corneal neovascularization and improve visual performance, few side effects have been described in the literature.

The pharmacological component is more effective in neovessels in their immature form as for electrocoagulation with a fine needle, it is more effective on the stable form of old neovessels in addition to corticosteroid treatment or anti-angiogenic treatment in conclusion the treatment of corneal neovessels has long been controversial, the advent of new anti-angiogenic molecules has revolutionized their management.

Fine-needle electrocoagulation is a simple physical means of treating stable corneal neovessels alone or even better in combination with anti-VEGF.