Photodynamic Therapy with Verteporfin Combined with Ranibizumab for Corneal Neovascularization Alexandra Peña, MD 1 ; Alejandro Navas, MD, MSc 2 ; Enrique O. Graue-Hernandez, MD, MSc 2 ; Guillermo Dewit, MD 1 ; Judith Sandra Sarmina, MD 1 ; Rodrigo Bolanos, MD 1 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 Dry Eye Disease Trauma Sequela Herpetic Keratitis Interstitial Keratitis Trauma Sequela Trauma Sequela 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 Trauma SLP 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. References 1.Stevenson W, Cheng S, et al. Corneal Neovascularization and the Utility of Topical VEGF Inhibition: Ranibizumab (Lucentis) Vs Bevacizumab (Avastin) Ocul Surf April ; 10(2): 67–83. 2.Priyanka P, Pooja V. et al. Subconjunctival Bevacizumab for Corneal Neovascularization. Cornea 2008;27: You IC,Im SK, et al. Photodynamic therapy with verteporfin combined with subconjunctival injection of bevacizumab for corneal neovascularization. Cornea 2011;30: Maddula, Surekha et al. Horizons in Therapy for Corneal Angiogenesis. Ophthalmology 2011; 118-3:591 – Hosseini H, Nowroozzadeh MH. et al. Anti-VEGF Therapy with Bevacizumab for anteriorsegment eye disease. Cornea 2012;31: