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Pellegrini M, Scorcia V, Giannaccare G, Lucisano A, Vaccaro S, Battaglia C, Yu AC, Bovone C, Busin M, Spena R. Corneal neovascularisation following deep anterior lamellar keratoplasty for corneal ectasia: incidence, timing and risk factors. THE BRITISH JOURNAL OF OPHTHALMOLOGY 2021; 106:1363-1367. [PMID: 33985961 DOI: 10.1136/bjophthalmol-2021-319339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia. METHODS This study included 616 eyes who underwent DALK between 2012 and 2020 in two tertiary referral centres. In one centre topical corticosteroids were discontinued after complete suture removal 1 year after surgery, whereas in the other they were discontinued 3-4 months after surgery. The presence and severity of corneal NV was ascertained based on slit lamp photographs. Potential risk factors for corneal NV were evaluated using the Cox proportional hazards model. RESULTS The cumulative incidence of corneal NV was 8.7% at 1 year after surgery and 13.2% at 5 years. Mean time interval from surgery to development of corneal NV was 12.8±16.2 months, with 68.9% of cases occurring before complete suture removal. Early discontinuation of topical steroids, older age and ocular allergy were associated with an increased risk of developing corneal NV (respectively, HR=2.625, HR=1.019, HR=3.726, all p<0.05). CONCLUSIONS The risk of corneal NV is higher in the first year following DALK. Early discontinuation of topical steroids, ocular allergy and older age are significant predictors of corneal NV.
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Affiliation(s)
- Marco Pellegrini
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Andrea Lucisano
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sabrina Vaccaro
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Caterina Battaglia
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Angeli Christy Yu
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.,University of Ferrara, Department of Translational Medicine, Ferrara, Italy
| | - Cristina Bovone
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.,University of Ferrara, Department of Translational Medicine, Ferrara, Italy
| | - Massimo Busin
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.,University of Ferrara, Department of Translational Medicine, Ferrara, Italy
| | - Rossella Spena
- Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy .,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.,University of Ferrara, Department of Translational Medicine, Ferrara, Italy
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Kwon HJ, Chung HS, Lee YM, Kim YJ, Ko BY, Kim HS, Chung TY, Hyon JY, Tchah H. Patients at High Risk for Failure of Penetrating Keratoplasty. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Liu H, Liu S, Tao H, Hu S, Deng Z, Tan J. A retrospective study comparing DALK and PKP in the treatment of necrotizing stromal keratitis. Int Ophthalmol 2020; 40:1713-1721. [PMID: 32207047 DOI: 10.1007/s10792-020-01339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the clinical outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) in the treatment of necrotizing stromal keratitis (NSK). METHODS A retrospective study of NSK patients who underwent keratoplasty between January 2015 and December 2017 in the Third Xiangya Hospital was carried out. Data including preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, graft survival rates, corneal endothelial cell density, corneal topography and thickness were reviewed and analyzed by SPSS 23.0 software. RESULTS Fifty patients were involved. Twenty-five patients received DALK, and the other half received PKP. The average follow-up period was 10.28 ± 5.92 months. At the end of the follow-up period, there were no significant differences in postoperative BCVA, recurrence of virus, graft rejection or graft failure between the two groups. There were also no significant differences in average central corneal thickness postoperatively at 3 months. However, the average corneal endothelial cell density at 3 months was significantly higher in the DALK group (2121.12 ± 450.80 cell/mm2 in the DALK group versus 1812.16 ± 340.38 cell/mm2 in the PKP group, P = 0.009). CONCLUSION Both DALK and PKP could increase visual acuity and prevent the progression of NSK. There were no significant differences between DALK and PKP in postoperative BCVA, rate of rejection, graft failure or recurrence rate. DALK significantly reduced the loss of corneal endothelial cells.
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Affiliation(s)
- Hanhan Liu
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Shuirong Liu
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Hui Tao
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Shuyu Hu
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, China
| | - Zhihong Deng
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, China.
| | - Jia Tan
- Department of Ophthalmology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410005, Hunan, China.
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Early Application of Bevacizumab After Sclerocorneal Grafting for Patients With Severe Late-Stage Ocular Chemical Burns. Cornea 2020; 39:754-760. [PMID: 32040009 DOI: 10.1097/ico.0000000000002272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether subconjunctival bevacizumab help prevent corneal graft neovascularization and prolong the graft survival of patients with chemical burns. METHODS We performed a prospective nonrandomized comparative case series study. Twenty-six eyes received subconjunctival bevacizumab (10 mg/0.4 mL) once and topical immunosuppressive agents after sclerocorneal lamellar keratoplasty as the treatment, and 13 eyes received a topical immunosuppressant alone and served as the control group. The main outcomes were a cumulative probability of graft survival, development of corneal neovascularization, and complications. RESULTS The postoperative follow-up time was 14.3 months (range, 2-62 mo). The cumulative graft survival time was significantly longer in the treatment group than that in the control group (42.9 ± 5.9 vs. 4.8 ± 0.7 mo; log rank < 0.001). In the treatment group, 19 of the 26 grafts (73.1%) survived as transparent with a mean follow-up of 18.7 ± 3.0 months. At the end of the follow-up, 4 grafts remained free of neovascularization, 2 developed edema without neovascularization, and 15 remained transparent with a stable ocular surface and some neovascular vessels in the peripheral transplant interface. The other 5 grafts became opaque and neovascularized. In the control group, all grafts became opaque and neovascularized within the follow-up period (5.5 ± 0.7 mo). During the follow-up, a corneal epithelial defect developed in 9 eyes in the treatment group and 7 in the control group. CONCLUSIONS Early application of subconjunctival bevacizumab after sclerocorneal lamellar keratoplasty can significantly prevent corneal neovascularization and promote graft survival for severe late-stage ocular chemical burns.
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Barraquer RI, Pareja-Aricò L, Gómez-Benlloch A, Michael R. Risk factors for graft failure after penetrating keratoplasty. Medicine (Baltimore) 2019; 98:e15274. [PMID: 31027083 PMCID: PMC6831321 DOI: 10.1097/md.0000000000015274] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022] Open
Abstract
The objective of our study was to define principal risk factors for graft failure in patients who underwent penetrating keratoplasty (PK).Retrospective data obtained from a cohort of 895 penetrating keratoplasties performed between 2001 and 2006 were analysed. Recipient related factors, graft characteristics, and surgical technique were assessed in a univariate analysis and with a multivariate proportional hazard model to detect principal risk factors for definitive graft failure.Multivariate analysis showed clear significance for diagnosis and number of previous grafts and border line significance for the oldest donor age group. Patients with keratoconus had the best 10-year survival estimate (95%), followed by endothelial and stromal dystrophies (both 55%), infectious leukomas (49%), trauma (33%) and chemical burns (14%). Primary PK grafts had a survival rate of 81%, second grafts of 33% and third or more grafts of 16%. Overall 10-year survival estimate based on univariate analysis was found to be 65%.In conclusion, we found that primary diagnosis and previous graft failures in the recipient are the most important risk factors of graft failure after a PK.
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Affiliation(s)
- Rafael Ignacio Barraquer
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Centro de Oftalmología Barraquer
- Universitat Internacional de Catalunya, Barcelona
| | - Luis Pareja-Aricò
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Hospital Clinico Universitario Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Alba Gómez-Benlloch
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Centro de Oftalmología Barraquer
| | - Ralph Michael
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona
- Centro de Oftalmología Barraquer
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Kuffova L, Knickelbein JE, Yu T, Medina C, Amescua G, Rowe AM, Hendricks RL, Forrester JV. High-Risk Corneal Graft Rejection in the Setting of Previous Corneal Herpes Simplex Virus (HSV)-1 Infection. Invest Ophthalmol Vis Sci 2016; 57:1578-87. [PMID: 27050878 PMCID: PMC4824377 DOI: 10.1167/iovs.15-17894] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The “high-risk phenotype” of corneal graft recipients is considered to be related to preexisting vascularization such as that associated with herpes simplex virus-1 (HSV-1) keratitis (HSK). The purpose of this study was to investigate the immunologic mechanisms underlying accelerated corneal graft rejection using a mouse model of HSK. Methods Herpes simplex virus type 1 keratitis was induced in BALB/c mice. Syngeneic and allogeneic (C57BL/6 mice) corneal grafts were performed in mice with HSK at different times after infection. Some grafts were performed on HSV-infected CD4 T cell–deficient BALB/c mice. Clinical, histologic, immunologic, and virus detection studies were performed on samples of cornea, draining lymph node (LN), and trigeminal ganglion (TG) cells. Results Corneal grafts in mice with HSK rejected with higher frequency and more rapid tempo compared with grafts in uninfected mice. In corneas with HSK and vascularization at the time of grafting, both syngeneic and allogeneic corneal grafts failed with similar frequency and tempo. However, in the absence of preexisting inflammation and vascularization, syngeneic grafts were accepted when the grafts were performed at a late time point after HSV infection (42 days), whereas allografts were rejected at this time. In contrast, syngeneic grafts in nonvascularized HSV-infected recipients failed if they were performed within 10 days of HSV infection, an effect that was dependent on CD4 T cells, as demonstrated using CD4 deficient mice. Importantly, a variably sustained but strongly positive anti-HSV T-cell response was detected in allografted HSK recipients with a similar but lesser response in syngeneic hosts. Conclusions A previous HSV-1 corneal infection predisposes donor grafts to a high risk of failure by both innate and adaptive immune mechanisms in which an anti-HSV CD4 T-cell response plays a prominent role.
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Affiliation(s)
- Lucia Kuffova
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, School of Medicine and Dentistry, Foresterhill, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Jared E Knickelbein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Tian Yu
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, School of Medicine and Dentistry, Foresterhill, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Carlos Medina
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Guillermo Amescua
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Alexander M Rowe
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Robert L Hendricks
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States 3Departments of Immunology, Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, Unite
| | - John V Forrester
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, School of Medicine and Dentistry, Foresterhill, University of Aberdeen, Aberdeen, Scotland, United Kingdom 4Ocular Immunology
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Abdelfattah NS, Amgad M, Zayed AA, Salem H, Elkhanany AE, Hussein H, Abd El-Baky N. Clinical correlates of common corneal neovascular diseases: a literature review. Int J Ophthalmol 2015; 8:182-93. [PMID: 25709930 DOI: 10.3980/j.issn.2222-3959.2015.01.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/19/2014] [Indexed: 12/14/2022] Open
Abstract
A large subset of corneal pathologies involves the formation of new blood and lymph vessels (neovascularization), leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization (CNV) by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis, contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatments available so far.
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Affiliation(s)
- Nizar Saleh Abdelfattah
- Doheny Image Reading Center, Doheny Eye Institute, University of California, Los Angeles, 1355 San Pablo Street, Los Angeles, California 90033, USA
| | - Mohamed Amgad
- Faculty of Medicine, Cairo University, Cairo 11956, Egypt
| | - Amira A Zayed
- Department of Surgery, Mayo Clinic, Rochester 55905, MN, USA
| | - Hamdy Salem
- Faculty of Medicine, University of Alexandria, Alexandria 21131, Egypt
| | - Ahmed E Elkhanany
- Department of Medical Oncology, Mayo Clinic, Rochester 55905, MN, USA
| | - Heba Hussein
- Faculty of Oral and Dental Medicine, Cairo University, Cairo 11956, Egypt
| | - Nawal Abd El-Baky
- Antibody Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, Alexandria 21934, Egypt
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Three-year corneal graft survival rate in high-risk cases treated with subconjunctival and topical bevacizumab. Graefes Arch Clin Exp Ophthalmol 2014; 253:287-94. [PMID: 25398659 DOI: 10.1007/s00417-014-2851-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the effect of combined subconjunctival and topical bevacizumab treatment on corneal graft survival rate in high-risk eyes. METHODS Prospective, consecutive, interventional case series. Fifty eyes of 50 high-risk patients scheduled for penetrating keratoplasty (PK) were included in the study; two Stevens-Johnson syndromes (SJS), five corneal combustions due to chemical burn, seven post-traumatic vascularised leucomas, 11 post-infectious vascularised leucomas, 19 rejected grafts and six corneal ulcers. Additional surgeries such as autologous limbal stem cell and/or amniotic membrane transplantation were performed together with PK in ten cases. All eyes received subconjunctival injection of 0.5 ml bevacizumab (25 mg/ml) after PK. Eyes with more than two quadrants of neovascularisation (NV) received bevacizumab drops (25 mg/ml) postoperatively for up to 12 weeks. Donor grafts were followed up for best-corrected visual acuity, graft clarity, change in NV, endothelial cell density loss (ECD), and adverse events. Mean follow-up was 36.5 months (range 32-61). RESULTS Best-corrected visual acuity increase was statistically significant in 82 % (41/50) of eyes 3 years after PK (paired t-test, p = 0.02). Thirty-five (70 %) high-risk grafts remained clear throughout the 3-year follow-up period. Decrease of corneal NV was observed in 84 % (42/50) of eyes treated with bevacizumab. ECD changed from preoperative 2,864 ± 301 down to 1,905 ± 187 cells/mm(2) at 3 postoperative years. A non-healing epithelial defect was recorded in one patient with SJS after 12 weeks of topical bevacizumab. CONCLUSION Combined subconjunctival and topical bevacizumab treatment may improve corneal graft survival rate in the majority of high-risk cases.
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Rolfsen ML, Frisard NE, Stern EM, Foster TP, Bhattacharjee PS, McFerrin Jr HE, Clement C, Rodriguez PC, Lukiw WJ, Bergsma DR, Ochoa AC, Hill JM. Corneal neovascularization: a review of the molecular biology and current therapies. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.13.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Benayoun Y, Rosenberg R, Casse G, Dallaudière B, Robert PY. [Imaging and quantification of corneal neovascularization]. J Fr Ophtalmol 2013; 36:693-703. [PMID: 23969009 DOI: 10.1016/j.jfo.2013.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/09/2013] [Accepted: 04/23/2013] [Indexed: 11/27/2022]
Abstract
Corneal neovascularization is defined as the invasion of vessels into the normally avascular clear corneal stroma, secondary to acute or chronic tissue injury. In addition to decreasing visual acuity, vascularity introduces circulating immune cells, reducing corneal immune privilege and the graft survival of subsequent keratoplasty. Thus, reducing neovascularization has become a recent therapeutic target in order to increase the success of corneal transplantation. Comparing the effects of antiangiogenic drugs assumes that we are able to quantify corneal neovascularization before and after treatment. In the first part of this literature review, we present the various methods to document neovessels (color photos, fluorescein and indocyanine green anterior segment angiography, in vivo confocal microscopy). Next, we report methods to classify and quantify corneal neovascularization.
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Affiliation(s)
- Y Benayoun
- Service d'ophtalmologie, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex 1, France; Service d'ophtalmologie, clinique François-Chénieux, 18, rue du Général-Catroux, 87039 Limoges cedex, France.
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[Corneal neovascularization: epidemiological, physiopathological, and clinical features]. J Fr Ophtalmol 2013; 36:627-39. [PMID: 23891320 DOI: 10.1016/j.jfo.2013.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/10/2013] [Accepted: 03/11/2013] [Indexed: 01/01/2023]
Abstract
Corneal neovascularization is defined as the presence of vessels within the normally avascular corneal stroma. This physiopathological process is the consequence of local hyper-expression of pro-angiogenic factors in response to tissue damage. These new vessels (neovessels), initially immature and poorly developed, predispose the cornea to lipid exudation, inflammation, and scarring. Additionally, the influx of vascular cells into the stroma induces a loss of the cornea's immune privilege, resulting in a higher rate of graft rejection. In this literature review, we touch on epidemiological, physiopathological, and clinical aspects of corneal neovascularization, as well as secondary complications.
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Bock F, Maruyama K, Regenfuss B, Hos D, Steven P, Heindl LM, Cursiefen C. Novel anti(lymph)angiogenic treatment strategies for corneal and ocular surface diseases. Prog Retin Eye Res 2013; 34:89-124. [PMID: 23348581 DOI: 10.1016/j.preteyeres.2013.01.001] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/17/2012] [Accepted: 01/04/2013] [Indexed: 12/21/2022]
Abstract
The cornea is one of the few tissues which actively maintain an avascular state, i.e. the absence of blood and lymphatic vessels (corneal [lymph]angiogenic privilege). Nonetheless do several diseases interfere with this privilege and cause pathologic corneal hem- and lymphangiogenesis. The ingrowths of pathologic blood and lymphatic vessels into the cornea not only reduce transparency and thereby visual acuity up to blindness, but also significantly increases the rate of graft rejections after subsequent corneal transplantation. Therefore great interest exists in new strategies to target pathologic corneal (lymph)angiogenesis to promote graft survival. This review gives an overview on the vascular anatomy of the normal ocular surface, on the molecular mechanisms contributing to the corneal (lymph)angiogenic privilege and on the cellular and molecular mechanisms occurring during pathological neovascularization of the cornea. In addition we summarize the current preclinical and clinical evidence for three novel treatment strategies against ocular surface diseases based on targeting pathologic (lymph)angiogenesis: (a) modulation of the immune responses after (corneal) transplantation by targeting pathologic (lymph)angiogenesis prior to and after transplantation, (b) novel concepts against metastasis and recurrence of ocular surface tumors such as malignant melanoma of the conjunctiva by anti(lymph)angiogenic therapy and (c) new ideas on how to target ocular surface inflammatory diseases such as dry eye by targeting conjunctival and corneal lymphatic vessels. Based on compelling preclinical evidence and early data from clinical trials the novel therapeutic concepts of promoting graft survival, inhibiting tumor metastasis and dampening ocular surface inflammation and dry eye disease by targeting (lymph)angiogenesis are on their way to translation into the clinic.
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Affiliation(s)
- Felix Bock
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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