Mitomycin-C Intravascular Chemoembolisation (Mice) And Intrastromal Injection For Corneal Neovascularisation

Corneal neovascularisation (NV) is a significant risk factor for visual impairment and corneal graft failure. The condition is frequently refractory to medical management, and currently available vasodestructive interventions often produce incomplete or transient regression. Mitomycin-C (MMC) intravascular chemoembolisation (MICE) is a novel angio-regressive technique that has demonstrated promising early outcomes; however, evidence remains limited, particularly with respect to real-world application and long-term safety. This study evaluates the long-term efficacy and safety of MICE, and targeted intrastromal MMC injection that has not previously been reported in the treatment of corneal neovascularisation.

Moorfields Eye Hospital 

A retrospective observational study was conducted involving adult patients with corneal NV who underwent treatment with MICE and intrastromal MMC injection. Intravascular MMC delivery was performed where corneal vessel cannulation was feasible; otherwise, targeted intrastromal MMC injection was undertaken. Pre- and postoperative vascularisation was assessed using ImageJ-based quantitative analysis, masked independent grading of slit-lamp photographs, and surgeon-reported outcomes. Best-corrected visual acuity, complications, and subsequent surgical interventions were recorded.

Thirty-two patients (33 eyes) were included. Cannulation alone was achieved in 13% of procedures, combined cannulation and intrastromal injection in 13%, and intrastromal injection alone in 74%. ImageJ analysis demonstrated NV regression in 72% of assessable cases. Surgeon-reported improvement or marked improvement was observed in 79% of eyes overall, and 78% of intrastromal-only cases (18/23). BCVA improved in six eyes, remained stable in 20, and declined in seven. Two serious complications (6%) occurred in anatomically high-risk eyes due to inadvertent MMC entry into the anterior chamber. Four eyes subsequently underwent keratoplasty without NV recurrence.

In the largest clinical cohort to date, MICE and not previously evaluated intrastromal MMC injection produced substantial regression of corneal NV. MMC-based angio-regression is the most effective treatment currently available and play an important role in stabilising high-risk corneas and optimising outcomes prior to keratoplasty.