ESCRS - FP28.02 - Photodynamic Therapy For The Management Of Lipid Keratopathy Secondary To Herpetic Keratitis

Photodynamic Therapy For The Management Of Lipid Keratopathy Secondary To Herpetic Keratitis

Published 2024 - 42nd Congress of the ESCRS

Reference: FP28.02 | Type: Free paper | DOI: 10.82333/e0pc-2w23

Authors: Carlos Solera De Andrés 1 , Margarita Zamorano Aleixandre* 2 , Ana Boto de los Bueis 1

1Ophthalmology,La Paz University Hospital,Madrid,Spain, 2Ophthalmology,Guadalajara University Hospital,Guadalajara,Spain

Purpose

To report the first case series study that prospectively demonstrates the quantitative effectiveness of photodynamic therapy (PDT) with verteporfin in reducing corneal neovascularization (CNV) and lipid keratopathy (LK) in patients with herpetic interstitial keratitis.

Setting

The disruption of the corneal angiogenic privilege can lead to CNV. New corneal vessels allow leakage and lipid deposition in the corneal stroma; this progressive and painless opacification due to lipid accumulation is a rare ophthalmological condition known as LK. Most treatments of LK aim to eliminate CNV. Many studies have reported improved visual acuity after PDT with Verteporfin for LK.

Methods

We prospectively evaluated patients with secondary LK due to herpetic keratitis who underwent PDT with Verteporfin. We analyzed visual acuity (VA), the percentage of corneal area with neo-vessels and LK, the percentage of total pathological area, neo-vessels count, its activity, and the corneal opacity  before and after PDT.

Results

We studied nine patients. The CNV area, LK extent, pathological area, vessel count, activity and corneal opacity all exhibited a statistically significant decrease in all patients following PDT. Complete vascular occlusion was observed in 5 eyes (55.5%), and partial occlusion in 3 eyes (33.5%). The mean post-treatment VA was 0.76 ± 0.32. VA improved by more than 1 line in 5 eyes (55.5%), with more than 2 line-improvement observed in 4 eyes (44.4%). It remain unchanged in 3 eyes (33.3%), while one patient (11%) worsened. No adverse effects were detected after a mean of 14.9 ± 3.9 years follow-up. There was no relapse of herpetic keratitis after discharging 88,8% patients (follow-up after discharged 8.1±4.6 years).

Conclusions

PDT with verteporfin is a safe and effective treatment of CNV and opacity in LK. It is a reproducible treatment in recurrent or persistent lesions. Additionally, PDT has succeeded in reducing recurrences of herpetic keratitis in our study.