ESCRS - PO027 - A Combined Approach To The Treatment Of Corneal Neovascularization Prior To Repeat Penetrating Keratoplasty: A Case Report

A Combined Approach To The Treatment Of Corneal Neovascularization Prior To Repeat Penetrating Keratoplasty: A Case Report

Published 2022 - 40th Congress of the ESCRS

Reference: PO027 | Type: Case report | DOI: 10.82333/3pe4-1j66

Authors: Cristina Tan* 1 , Victor Caparas 1

1Eye and Vision Institute,The Medical City,Pasig City,Philippines

We report the management of severe corneal stromal neovascularization in a post-tectonic penetrating keratoplasty patient. To reduce the risk of rejection prior to replacement with an optical graft, a combination of intrastromal injection with Bevacizumab followed by fine needle diathermy was performed.

The Eye and Vision Institute at The Medical City, Pasig, Philippines

A 48 year-old male underwent tectonic penetrating keratoplasty for a corneal perforation secondary to fungal keratitis. The infection was successfully treated, however, multiple deep corneal stromal vessels developed within one and a half months post-op. To reduce the risk of rejection from severe neovascularization prior to replacement with an optical graft, a combination of intrastromal injection and fine needle diathermy was performed. A series of intrastromal and subconjunctival injections with  Bevacizumab (0.02 ml, 25mg/ml) successfully treated superficial, immature vessels while fine needle diathermy successfully treated deep, mature stromal vessels. With resolution of the deep stromal vessels, a penetrating keratoplasty with an optical graft was successfully performed. One year and 3 months later, UCVA is 20/30 with no signs of rejection or neovascularization.

The use of intrastromal Anti-VEGF combined with fine needle diathermy are essential in the treatment of severe corneal neovascularization prior to optical penetrating keratoplasty, which can aid in reducing the risk of graft rejection in these cases.