Strategies for targeting corneal neovascularization

Approaches include anti-vascular endothelial growth factor agents, fine needle diathermy, and corneal collagen crosslinking.

Clinically available angioregressive strategies to target corneal neovascularization, a prime factor in graft rejection following keratoplasty, are showing promising results, according to Claus Cursiefen, MD, PhD, and Deniz Hos, MD, PhD, from the Department of Ophthalmology, University of Cologne, Faculty of Medicine, University Hospital Cologne, and the Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.

Cursiefen and Hos recently described clinically available approaches1 that address corneal neovascularization before penetrating keratoplasty is performed with the goal of improving graft survival postoperatively and discussed findings on Descemet membrane endothelial keratoplasty (DMEK) in eyes with neovascularization.

The clinical approaches include the use of anti-vascular endothelial growth factor agents, fine needle diathermy, and corneal collagen crosslinking (CXL), all designed to cause regression of corneal neovascularization before penetrating keratoplasty. The authors also presented the outcomes of DMEK in vascularized eyes.

Targeting corneal neovascularization

Cursiefen and Hos reported that when recipient corneas were pretreated with fine needle diathermy in conjunction with anti-vascular endothelial growth factor drugs, this effectively reduced long-standing corneal neovascularization. This approach resulted in relatively low rates of graft rejection rates after subsequent high-risk penetrating keratoplasty.

CXL applied to the peripheral cornea also seemed to be a highly effective method to cause regression of corneal neovascularization; however, the investigators pointed out that the data are not yet available on the impact of CXL performed before graft transplantation on the long-term graft survival.

They also noted the availability of limited data regarding the graft rejection rates following DMEK in vascularized eyes. However, they commented that the initial studies have indicated that DMEK appears to be a “viable therapeutic option” in the absence of stromal scars. They also noted that any preexisting stromal neovascularization regressed after high-risk DMEK was performed.

Based on their findings, Cursiefen and Hos concluded, “Several angioregressive strategies to treat corneal neovascularization before penetrating keratoplasty have entered the clinic with promising initial results, which warrants larger trials with longer follow-up. Studies will also have to define the precise role of preexisting corneal neovascularization in high-risk DMEK.”

  1. Cursiefen C, Hos D. Cutting edge: novel treatment options targeting corneal neovascularization to improve high-risk corneal graft survival. Cornea. 2021;40:1512-8; doi: 10.1097/ICO.0000000000002736