Fine Needle Diathermy and Intraestromal Bevacizumab: A Combined Treatment for Corneal Neovascularization

Patricia Bayo-Calduch*, Jorge Vila-Arteaga and Jose Francisco Marí-Cotino

Fine Needle Diathermy and Intraestromal Bevacizumab:
A Combined Treatment for Corneal Neovascularization

The cornea, supplied by the ophthalmic artery throught the ciliary arteries that come to an end
near the limbus in the so called pericorneal plexus, is an avascular and transparent tissue.

Under normal conditions, such transparency is due to the high level of anti-angiogenic molecules and
thus a low level of angiogenic molecules.

Any alteration of this balance may cause corneal
neovascularization, defined as the growth of new blood vessels from previous capillaries
and venules from the pericorneal plexus, which invade the cornea leading to inflammation
and chronic corneal edema, lipidic exudation, estromal hemorrhage and corneal scarring.

Subsequently, corneal neovascularization may lead to reduced visual acuity and worsening of
penetrating queratoplasty prognosis after the alteration of the well-known immune privilege of the cornea

Prevalence of corneal neovascularization in the United States is known to be 4.14%,
presenting 12% of the cases in association with visual loss.

The leading causes of corneal neovascularization are known to be infections,
contact lens misuse and the vascular response associated to corneal transplantation.

Now-a-days there is a variety of treatments for corneal neovascularization such as
topical corticoesteroids and non-steroidal anti-inflammatories, anti-angiogenic therapies such
as bevacizumab, ciclosporine A, diathermy direct occlusion of vessels, topical ascorbic acid,
criotherapy, photodynamic theraphy, laser photocoagulation and superficial queratectomy

A 44 year-old female presents with lagophtalmos in her right
eye (RE) secondary to post-operative facial palsy after acoustic neuroma.

Previously treated with hialuronic acid injections in the upper lid, lateral tarsorrhaphy and gold weight eyelid
implant, the patient presented with relapsing corneal ulcer and corneal inferior neovascularization resistant to conservative treatment, which led us to treat with fine needle diathermy and intraestromal bevacizumab.

Ophthalmol Open J. 2016; 1(1): 17-20. doi: 10.17140/OOJ-1-105