Intense Pulsed Light As Adjunctive Therapy In Refractory Inflammatory Corneal Neovascularization: A Case Report

Corneal neovascularisation (CNV) secondary to severe autoimmune dry eye remains therapeutically challenging. Anti-VEGF therapy may be insufficient in inflammation driven cases. We report regression of progressive 360 CNV following periocular intense pulsed light (IPL) in a patient with clinically diagnosed seronegative Sjogren syndrome.

private ophthalmology clinic with referral to a tertiary public corneal service for advanced management. 

A 55 year old female with clinically diagnosed Sjogren syndrome underwent uncomplicated phacoemulsification in 2022. After discontinuation of systemic steroids in late 2023, she developed a persistent epithelial defect progressing to corneal abscess and sectoral CNV in the right eye. Despite intense lubricants, vitamin A ointment, amniotic membrane transplantation (November 2024), and multiple subconjunctival afliberecept injections between February and August 2025, neovascularisation progressed from temporal involvement to 360 limbal encroachment. Visual acuity deteriorated to counting fingers.

In August and September 2025, two sessions of periocular IPL were performed targeting severe meibomian gland dysfunction and inflammatory lid margin disease, supported by slit lamp documentation of frothy discharge and bilateral surface involvement.

In this case, periocular IPL was associated with regression of progressive inflammatory CNV refractory to anti-VEGF therapy. The observed improvement is hypothesized to result from modulation of ocular surface inflammation rather than direct vascular photocoagulation. While this association suggests a potential therapeutic role, causality cannot be established from a single case, and larger controlled studies are required to confirm efficacy and mechanism.