1. Verteporfin Photodynamic Therapy in Patients with Corneal Neovascularization Rodrigo Bolanos MD 1, Alexandra Pena MD 1, Guillermo Dewit MD 1, Judith Sandra Sarmina MD 1, Enrique O. Graue-Hernández, MD, MSc 2, Alejandro Navas, MD, MSc 2. 1) Opthalmology Service, Regional Hospital, Adolfo López Mateos, ISSSTE. Mexico City, Mexico. 2) Institute of Ophthalmology “Conde de Valenciana, Mexico.

2. Financial Disclosure -RB, AP, GD, JSS & EOGH: No financial interest or relationship to disclose. -AN: Carl Zeiss Meditec, Consultant (A); Alcon Laboratories, Consultant (B) and STAAR Surgical, Consultant (B).

3. Purpose To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne) on corneal neovascularization (CNV) in twenty patients. Ten patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Methods

4. Postoperative outcomes 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.

5. Results Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the ten patients, and regression was verified by corneal fluorescein and ICG angiography. In five cases, partial vessel recanalization was observed after 6 weeks, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases.

6. High-magnification clinical photograph: corneal neovascular network and the perikeratic circle are markedly congested with edema and superficial hemorrhages. Six months after the second treatment, the cornea was notable improvement of vascularization. Show Slit Lamp picture (SLP), indocianine green picture (ICG) and Corneal Angiography (CA). SL CAICG SL CA Baseline 6 months after ICG

7. Pretreatment middle-phase corneal fluorescein and ICG frames, showing perfusion and leakage from the neovascular network. Middle-phase corneal fluorescein and ICG frames taken 6 months after the second PDT; notably diminished corneal neovascularization was found. Show Slit Lamp picture (SLP), indocianine green picture (ICG) and Corneal Angiography (CA). Baseline 6 months after SL ICG CA

8. Disease Visual Acuity LogMAR at baseline Percentage of Vascularization % at baseline Visual Acuity LogMAR at 6 months Percentage of Vascularization % at 6 months Herpes Simplex Virus 1.30501.015 Herpes Zoster 1.30600.8410 Herpes Simplex Virus 1.30800.8410 Herpes Simplex Virus 1.0300.845 Trauma sequelae1.0 30 0.69 5 Interstitial keratitis 1.30600.6010 Trauma sequelae 1.0300.845 Trauma sequelae 0.84300.695 Sjögren's Syndrome 0.69300.6010 Herpes Zoster 1.0301.015

9. Results STATA 8.0 and Paired t test were used for statistical analysis for corneal vascularization showing differences before and after treatment P=0.001

10. Conclusions PDT with verteporfin could be an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required. 1)Cursiefen C, Kuchle M, Naumann GOH. Angiogenesis in corneal disease: histopathologic evaluation of 254 human corneal buttons with neovascularization. Cornea. 1998;17:611–613. 2)Azar DT. Corneal angiogenic privilege: angiogenic and antiangiogenic factors in corneal avascularity, vasculogenesis and wound healing (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006;104:264–302. 3)Epstein RJ, Hendricks RL, Harris DM. Photodynamic therapy for corneal neovascularization. Cornea. 1991;10:424–432. References