Verteporfin Photodynamic Therapy in Patients with Corneal Neovascularization

Rodrigo Bolanos MD1, Alexandra Pena MD1, Guillermo Dewit MD1, Judith Sandra Sarmina MD1, Enrique O. Graue-Hernández, MD, MSc2, Alejandro

Navas, MD, MSc2.

1) Opthalmology Service, Regional Hospital, Adolfo López Mateos, ISSSTE. Mexico City, Mexico.

2) Institute of Ophthalmology “Conde de Valenciana, Mexico.

Financial Disclosure

- RB, AP, GD, JSS & EOGH: No financial interest or relationship to disclose.

- AN: Carl Zeiss Meditec, Consultant (A); Alcon Laboratories, Consultant (B) and STAAR Surgical, Consultant (B).

Purpose

• To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in twenty patients.

• Ten patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin.

Methods

Methods

• Postoperative outcomes of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months.

Results

• Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the ten patients, and regression was verified by corneal fluorescein and ICG angiography.

• In five cases, partial vessel recanalization was observed after 6 weeks, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases.

• High-magnification clinical photograph: corneal neovascular network and the perikeratic circle are markedly congested with edema and superficial hemorrhages. Six months after the second treatment, the cornea was notable improvement of vascularization. Show Slit Lamp picture (SLP), indocianine green picture (ICG) and Corneal Angiography (CA).

SL CAICG

SL CA

Baseline

6 monthsafter

ICG

• Pretreatment middle-phase corneal fluorescein and ICG frames, showing perfusion and leakage from the neovascular network. Middle-phase corneal fluorescein and ICG frames taken 6 months after the second PDT; notably diminished corneal neovascularization was found. Show Slit Lamp picture (SLP), indocianine green picture (ICG) and Corneal Angiography (CA).

Baseline

6 monthsafter

SL

SL

ICG

ICG

CA

CA

DiseaseVisual Acuity LogMAR at

baseline

Percentage of Vascularization % at baseline

Visual Acuity LogMAR at 6

months

Percentage of Vascularization % at 6 months

Herpes Simplex Virus

1.30 50 1.0 15

Herpes Zoster 1.30 60 0.84 10

Herpes Simplex Virus

1.30 80 0.84 10

Herpes Simplex Virus

1.0 30 0.84 5

Trauma sequelae 1.0 30 0.69 5

Interstitial keratitis 1.30 60 0.60 10

Trauma sequelae 1.0 30 0.84 5

Trauma sequelae 0.84 30 0.69 5

Sjögren's Syndrome 0.69 30 0.60 10

Herpes Zoster 1.0 30 1.0 15

Results

• STATA 8.0 and Paired t test were used for statistical analysis for corneal vascularization showing differences before and after treatment P=0.001

Conclusions

• PDT with verteporfin could be an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required.

1) Cursiefen C, Kuchle M, Naumann GOH. Angiogenesis in corneal disease: histopathologic evaluation of 254 human corneal buttons with neovascularization. Cornea. 1998;17:611–613.

2) Azar DT. Corneal angiogenic privilege: angiogenic and antiangiogenic factors in corneal avascularity, vasculogenesis and wound healing (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006;104:264–302.

3) Epstein RJ, Hendricks RL, Harris DM. Photodynamic therapy for corneal neovascularization. Cornea. 1991;10:424–432.

References