Photodynamic Therapy with Verteporfin Combined with Ranibizumab for Corneal

Neovascularization

Alexandra Peña, MD1; Alejandro Navas, MD, MSc2; Enrique O. Graue-Hernandez, MD, MSc2; Guillermo Dewit, MD1; Judith Sandra Sarmina,

MD1; Rodrigo Bolanos, MD1

1) Department of Ophthalmology, ISSSTE Regional Hospital Adólfo López Mateos, Mexico City.

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

Financial Interest Disclosure

- AP, EOGH GD, JSS & RB: 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) and subconjuntival Ranibizumab (Lucentis) on corneal neovascularization (CNV) in seven patients.

Methods

• 7 patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin and subconjunctival Ranibizumab 1.0mg (1.0 mg/0.10 mL) administration at the same time.

Methods

• Postoperative outcome 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.

Clinical data at initial presentation and final follow-up.

Etiology of CV Visual Acuity LogMAR

Corneal vascularization

%

Visual Acuity

LogMAR

Corneal vascularization

%

1 Herpetic Keratitis 2.0 70 2.0 20

2 Dry Eye Disease 0.47 35 0.47 10

3 Trauma Sequela 2.0 30 2.0 10

4 Herpetic Keratitis 1.0 20 0.84 10

5 Interstitial Keratitis 1.0 50 0.60 15

6 Trauma Sequela 0.84 50 0.69 20

7 Trauma Sequela 1.0 20 0.84 10

BASELINE 8 WEEKS

Fig. 1: Clinical photographs of progressive corneal neovascularization due to herpetic keratitis prior to treatment (A) ; Corneal neovascularization secondary to trauma. Note a large vessel area and dye leakage. (color, red-free and fluorescein angiography imaging). Slit Lamp Picture (SLP); Fluorescein angiography (FA).

Initial presentation

A.

B.

Herpetic keratitis

TraumaSLP FA

Results

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

• In all cases, regression of new vessels was observed after 8 weeks. No relevant side effects were observed in our cases.

Fig. 2 Fluorescein angiography imaging prior to treatment and at weeks 4 and 8 respectively. Note the significant reduction in area covered by pathologic corneal neovessel reduction in vessel diameter and dye leakage.

Follow-up

Herpetic keratitis

Trauma

4 WEEKS 8 WEEKS

Statistical analysis

• 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• Combined administration of PDT with Verteporfin

and subconjunctival Ranibizumab could be an effective and safe procedure for patients with corneal neovascularization.

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