Corneal Angiography for Guiding and Evaluating Fine-Needle Diathermy Treatment of Corneal Neovascularization



Spiteri, Natasha, Romano, Vito ORCID: 0000-0002-5148-7643, Zheng, Yalin ORCID: 0000-0002-7873-0922, Yadav, Sohraab, Dwivedi, Rahul, Chen, Jern, Ahmad, Sajjad, Willoughby, Colin E and Kaye, Stephen B ORCID: 0000-0003-0390-0592
(2015) Corneal Angiography for Guiding and Evaluating Fine-Needle Diathermy Treatment of Corneal Neovascularization. OPHTHALMOLOGY, 122 (6). pp. 1079-1084.

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Abstract

<h4>Purpose</h4>To investigate the outcome of selective occlusion of the afferent vessel of corneal neovascular complexes (CoNVs), using angiographically guided fine-needle diathermy (FND).<h4>Design</h4>Retrospective interventional case series.<h4>Subjects</h4>Patients with CoNV unresponsive to topical steroid therapy.<h4>Methods</h4>Visual acuity, color images, and fluorescein angiography and indocyanine green angiography were measured before and after FND with a minimum of 3 months of follow-up. The number of afferent vessels crossing the limbus, time to fluorescein leakage, area, and geometric properties of the CoNV were determined using an in-house automated program written in numerical computing language (MatLab R14; The MathWorks Inc., Natick, MA). The location of the afferent vessel was identified from the angiographic images and marked at the slit lamp using a needle to make a cut to the depth of the vessel. We then applied FND using an electrolysis needle.<h4>Main outcome measures</h4>Area of CoNV.<h4>Results</h4>Thirty patients underwent FND for CoNV that had not responded to treatment with topical steroids. The CoNV was associated with previous microbial keratitis (n = 26), intrastromal corneal ring segments (n = 2), ectodermal dysplasia (n = 1), and corneal choristoma (n = 1). Duration of CoNV was >6 months in 23 patients (77%), between 3 and 6 months in 3 patients (10%), and <3 months in 5 patients (13%). The number of afferent vessels per CoNV ranged from 1 to 3, with a mean diameter of 40 μm (standard deviation [SD], 10 μm) and mean time to leakage from apical vessels was 44.22 seconds (minimum, 27.43 seconds; maximum, 63.59 seconds). The number of FND treatments that were required was 1 for 20 patients (66.6%), 2 for 8 patients (26.6%), and 3 for 2 patients (6.6%). After FND, the area of CoNV reduced by 1.80 mm(2) (SD, 1.40 mm(2)), from 2.42 (SD, 1.59) to 0.62 mm(2) (SD, 0.73 mm(2)) up to 12 weeks postoperatively (P < 0.01).<h4>Conclusions</h4>The differentiation of afferent and efferent vessels using corneal angiography enables treatment to be selectively applied to the afferent vessels; there are usually 1 to 2 for each CoNV complex.

Item Type: Article
Uncontrolled Keywords: Cornea, Humans, Corneal Neovascularization, Indocyanine Green, Fluorescein Angiography, Diathermy, Surgery, Computer-Assisted, Retrospective Studies, Visual Acuity, Adult, Aged, Aged, 80 and over, Middle Aged, Coloring Agents, Female, Male, Young Adult
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Depositing User: Symplectic Admin
Date Deposited: 23 Mar 2015 15:59
Last Modified: 16 Dec 2022 16:50
DOI: 10.1016/j.ophtha.2015.02.012
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/2008698