Posters

Corneal vessels: fine needle diathermy or subconjunctival injection of anti-VEGF?

Poster Details

First Author: I.Adnane MOROCCO

Co Author(s): M. Essakhi   A. Mchachi   L. Benhmidoune   R. Rachid   M. Elbelhadji        

Abstract Details

Purpose:

The cornea is a tissue maintained avascular thanks to a balance between the antiangiogenic factors expressed at its level and the repression of pro-angiogenic factors.Corneal vessels develop from  peri-corneal veinlets at the level of the limbus. Corneal vessels management has benefited from advances in medical research especially when it comes to the treatment of angiogenesis, which has made it possible to switch from corticosteroids that provide numerous side effects to anti-angiogenic molecules and even lasers. Purpose of the study: to compare the efficacy of subconjugate injections of anti-VEGF with that of fine needle electrocoagulation in the treatment of corneal neo-vessels

Setting:

We conducted a prospective comparative study  approved by our hospital's ethics committee. Sixty patients were included, all of whom had corneal vessels on a stromal scar following a treated corneal abscess that we decided to take in order to prepare them for corneal transplant.Vessels were stable and non inflammatory.

Methods:

For the treatment of these corneal vessels patients were randomly divided into three groups of 20 patients: the first group received subconjunctival injections of Bevacizumab (0.1ml of a concentration of Bevacizumab at 25 mg / mL at one month interval), the second a fine needle electrocoagulation, and the third group a combination of the two treatments. Parameters studied were: visual acuity, vascularized corneal surface and maximal regeneration of vessels judged on color photographic snapshots and tolerance to the different therapeutics used. All patients received regular follow-up with an average assessment after six months of treatment

Results:

The initial best corrected visual acuity ranged from fingers count to 20/100(0.2), 39 patients had neovascularization of the two lower quadrants of the cornea, 26 of them had superficial corneal vessels. For the group of patients who received subconjunctival injections of bevacizumab, we noted a maximal regression of the vessels in 7 patients,Regarding the second group treated by fine needle electrocoagulation,12 cases had a favorable response to the treatment with a disappearance of the neovascularization and for the last group that received the combination of the two treatments, we noted 17 cases of correct response was observed.

Conclusions:

The treatment of corneal neovascular diseases has long been controversial and the advent of new anti-angiogenic molecules has revolutionized their management. However, their efficacy remains limited to the acute phase with hyper-expression of VEGF. Fine needle diathermy is a simple physical method for the management of stable corneal vessels .This technique can be used alone or in combination with other therapeutics mentioned above. Although our experience has supported this observation, the medium- to long-term evolution will be carried out in a subsequent study on a wider sampling so that the tolerance and the duration of this technique can be studied

Financial Disclosure:

None