The cornea is unique because of its complete avascularity. Corneal neovascularization (CNV) can result from a variety of etiologies including contact lens wear; corneal infections; and ocular surface diseases due to inflammation, chemical injury, and limbal stem cell deficiency. Management is focused primarily on the etiology and pathophysiology causing the CNV and involves medical and surgical options. Because inflammation is a key factor in the pathophysiology of CNV, corticosteroids and other anti-inflammatory medications remain the mainstay of treatment. Anti-VEGF therapies are gaining popularity to prevent CNV in a number of etiologies. Surgical options including vessel occlusion and ocular surface reconstruction are other options depending on etiology and response to medical therapy. Future therapies should provide more effective treatment options for the management of CNV.

Current and emerging therapies for corneal neovascularization

Purpose To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. Setting Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Retrospective case series. Methods All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. Results The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. Conclusions When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.

Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes.

A majority of phakic patients undergoing pars plana vitrectomy for epiretinal membrane or macular hole require subsequent cataract surgery within 1–2 years Combined phaco-vitrectomy eliminates the need for a second surgery and may enable patients to attain their best vision sooner This study aims to compare the visual outcomes, complication rates, and costs of combined phaco-vitrectomy versus sequential vitrectomy followed by cataract surgery Records were searched by CPT® codes to identify patients with both cataract and vitrectomy surgery at our institution over a 5-year period (2013–2018) Chart review included medical history, demographics, exam findings, operating room records, visual acuity (VA), and clinical outcomes Statistical analyses were performed with SPSS v19 (IBM) Area under the curve for visual acuity was calculated as the trapezoidal mean of the change in Early Treatment of Diabetic Retinopathy Study letters After exclusion, 81 eyes of 78 patients underwent both cataract and vitrectomy surgeries at our institution Thirty-four eyes underwent separate, sequential vitrectomy then phacoemulsification surgery, and 47 eyes had combined phaco-vitrectomy surgery Total operating room times (12081 ± 341 vs 16103 ± 545 min; p < 00001) and associated costs were significantly lower in the combined surgery compared with those in the sequential surgery group Baseline and final visual acuity were similar between the two groups Baseline VA was 3553 letters (~ 20/200) and 3281 letters (~ 20/220) and increased to final VA of 6374 (~ 20/53) and 6091 letters (~ 20/61), in the sequential and combined groups respectively Area under the curve for vision was greater in the combined surgery group, with subjects gaining an average of + 911 ± 332 letters from sequential surgery, and + 1953 ± 353 letters in the combined surgery group (p = 004) Additionally, patients in the combined group attained their best visual acuity 449 days (15 months) sooner than those receiving sequential surgery Combined phaco-vitrectomy surgery resulted in greater area under the curve visual acuity benefit and attainment of best visual acuity 15 months sooner compared with conventional sequential surgeries There were no significant differences in complication rates or clinical outcomes between the groups, but operative times and costs were lower for combined surgery, supporting a favorable cost-benefit ratio

Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification

Corneal neovascularization (CNV) is a common pathological change in ocular surface diseases. It is not only the factor that affects vision but also the main cause for corneal graft failure. Based on the mechanism of CNV, many achievements have been developed to suppress the formation of CNV. There are certain novel drugs such as aflibercept, gold nanoparticles, and netrins which provide us with new clues to treat CNV. However, we still need to develop more effective therapeutic drugs. It is of great significance to develop new effective drugs to suppress the occurrence of CNV. In this paper, recent drug therapies for CNV are reviewed. The electronic database (PubMed) is searched for relative basic research and randomized clinical trials that are published recently.

Recent drug therapies for corneal neovascularization

Many authors have reported on a myopic post-operative refractive prediction error when combining phacoemulsification with pars plana vitrectomy (phacovitrectomy). In this study we evaluate the amount of this error in our facility and try to elucidate the various factors involved. This was a retrospective study which included 140 patients who underwent phacovitrectomy (39 with macular holes, 88 with puckers, and 13 with floaters). Post-operative refractive error was defined as the difference between the actual spherical equivalent (SEQ) and expected SEQ based on the SRK/T and Holladay-II formulas. Both univariate (paired t test, independent t test, one-way analysis of variance, or Mann–Whitney test) and multivariate (regression analysis) statistical analyses were performed. Overall, a refractive error of − 0.13 dpt (p = 0.033) and − 0.26 dpt (p < 0.01) were found in the SRK/T and Holladay-II formulas, respectively. For the independent diagnoses, only macular holes showed a myopic error with the SRK/T (− 0.31 dpt; p < 0.01) and Holladay-II (− 0.44 dpt; p < 0.01) formulas. In univariate analysis, significant factors involved in myopic refractive error were macular hole as diagnosis (p < 0.01 for SRK/T and Holladay-II), gas tamponade (SRK/T p = 0.024; Holladay-II p = 0.025), pre-operative myopia (p < 0.01 for SRK/T), and optical technique for axial length measurement (SRK/T and Holladay-II p < 0.01). In the multivariate analysis, pre-operative axial length (p = 0.026), optical technique for axial length measurement (p < 0.01), and pre-operative SEQ (p < 0.01) were independent predictors for myopic refractive error in the SRK/T formula. For the Holladay-II formula, optical technique for axial length measurement (p < 0.01) and pre-operative SEQ (p = 0.04) were predictive. Various factors are involved in determining the myopic refractive error after phacovitrectomy. Not every factor seems to be as important in each individual patient, suggesting a more tailored approach is warranted to overcome this problem.

/pdf/post-operative-refractive-prediction-error-after-363z8np5wa.pdf

Post-operative Refractive Prediction Error After Phacovitrectomy: A Retrospective Study

Purpose: To examine the effects of panretinal photocoagulation (PRP) using a pattern scanning laser (PASCAL) system on the retinal nerve fiber layer (RNFL) thickness in patients with diabetic retinopathy. Methods: This retrospective study included 105 eyes with diabetic retinopathy, which consisted of three groups: the PASCAL group that underwent PRP with the PASCAL method (33 eyes), the conventional group that underwent conventional PRP treatment (34 eyes), and the control group that did not receive PRP (38 eyes). The peripapillary RNFL thickness was measured by optical coherence tomography before, six months, and one year after PRP to evaluate the changes in peripapillary RNFL. Results: The RNFL thickness in the PASCAL group did not show a significant difference after six months (average 3.7 times, p = 0.15) or one year after the PRP (average 3.7 times, p = 0.086), whereas that in the conventional group decreased significantly after six months (average 3.4 times, p < 0.001) and one year after PRP (average 3.4 times, p < 0.001). Conclusions: The results of this study suggest that the PASCAL system may protect against RNFL loss by using less energy than conventional PRP.

https://synapse.koreamed.org/upload/SynapseData/PDFData/0065kjo/kjo-28-220.pdf

Changes in peripapillary retinal nerve fiber layer thickness after pattern scanning laser photocoagulation in patients with diabetic retinopathy.

AIM: To examine the refractive prediction error in high myopic eyes after phacovitrectomy. METHODS: This retrospective comparative case series included 91 eyes (18 high myopic eyes and 73 non-high myopic eyes) of 91 patients who underwent successful phacovitrectomy (phacoemulsification, intraocular lens implantation, and pars plana vitrectomy). The high myopic eyes were defined as the eye with more than 26.0 mm of axial length. The postoperative prediction error of mean error and mean absolute error were evaluated at 4mo postoperatively. Axial length and keratometry measurement were performed preoperatively and 4mo postoperatively using the IOL Master. RESULTS: The refractive outcome after phacovitrectomy showed significantly greater myopic shift in the high myopic eyes [-1.08±0.87 diopters (D)] than that in the non-high myopic eyes (-0.43±0.63 D, P=0.004). Axial length and keratometric value in the high myopic eyes were significantly increased (P=0.043, 0.037 respectively), whereas those in the non-high myopic group were not significantly increased (P=0.135, 0.347 respectively). The change of the axial length in the myopic eye (0.46±0.28 mm) was greater than that in the non-high myopic eye (0.11 ± 0.34 mm; P<0.001). CONCLUSION: High myopic eyes showed more myopic shift than non-high myopic eyes after phacovitrectomy. The cause of myopic shift in high myopic eyes seems to be attributed to actual elongation of the axial length in high myopia.

Refractive errors in high myopic eyes after phacovitrectomy for macular hole.

incurrence of subcutaneous tissue adhesion at the resection site, leading to other cosmetic problems. In conclusion, the AFI for facial augmentation widely performed as a convenient and safe cosmetic procedure at present can cause unexpected complications such as inflammation and lipogranuloma formation at the periorbital area. Therefore, it requires caution, and sufficient explanation should be given to the patient before the surgery.

Monoclonal gammopathy of undetermined significance maculopathy

PURPOSE To examine the inhibitory effect of topical aflibercept [vascular endothelial growth factor (VEGF) trapR1R2] on corneal neovascularization (NV) in rabbits. METHODS Corneal NV was induced in 24 eyes of 12 rabbits. Seven days after a silk suture in the corneal stroma, the rabbits were divided into 4 groups of 6 eyes each. Two groups were treated with topical aflibercept at 2 different concentrations: 2 mg/0.5 mL (0.1%, group 1) and 2 mg/5 mL (0.01%, group 2). The other 2 groups were treated with topical bevacizumab 2.5 mg/1 mL (0.1%, group 3) and topical balanced salt solution (group 4, control). The concentration of VEGF and placental growth factor (PIGF) messenger RNA (mRNA) was measured by reverse transcriptase-polymerase chain reaction. RESULTS The surface area of NV was significantly smaller in the treatment groups compared with that of the control group. The expression of VEGF mRNA was 0.227 in 0.1% aflibercept (group 1), 0.811 in 0.01% aflibercept (group 2), and 0.495 in 0.1% bevacizumab (group 3). There was a significant decrease in the VEGF concentration in all 3 treatment groups compared with the control group, 1.491 (P = 0.031, <0.05). In the 0.01% aflibercept group, the difference was less than that of the 0.1% aflibercept and 0.1% bevacizumab groups. There was no significant difference in the 0.1% aflibercept and 0.1% bevacizumab groups. The expression of PIGF mRNA was 0.791 in 0.1% aflibercept (group 1), 0.743 in 0.01% aflibercept (group 2), 1.194 in 0.1% bevacizumab (group 3), and 1.458 in the control group. The expression of PIGF mRNA was significantly decreased in the 0.1% aflibercept and 0.01% aflibercept groups. CONCLUSIONS Topical aflibercept may have an inhibitory effect on corneal NV in rabbits.

Inhibitory Effect of Topical Aflibercept on Corneal Neovascularization in Rabbits.

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Papers

Changes in peripapillary retinal nerve fiber layer thickness after pattern scanning laser photocoagulation in patients with diabetic retinopathy.

Refractive errors in high myopic eyes after phacovitrectomy for macular hole.

Monoclonal gammopathy of undetermined significance maculopathy

Inhibitory Effect of Topical Aflibercept on Corneal Neovascularization in Rabbits.