title: Corneal angiography for guiding and evaluating fine-needle diathermy treatment of corneal neovascularization.
abstract: OBJECTIVE
  To investigate the outcome of selective occlusion of the afferent vessel of corneal neovascular complexes (CoNVs), using angiographically guided fine-needle diathermy (FND).
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Patients with CoNV unresponsive to topical steroid therapy.
  
  
  METHODS
  Visual acuity, color images, and fluorescein angiography and indocyanine green angiography were measured before and after FND with a minimum of 3 months of follow-up. The number of afferent vessels crossing the limbus, time to fluorescein leakage, area, and geometric properties of the CoNV were determined using an in-house automated program written in numerical computing language (MatLab R14; The MathWorks Inc., Natick, MA). The location of the afferent vessel was identified from the angiographic images and marked at the slit lamp using a needle to make a cut to the depth of the vessel. We then applied FND using an electrolysis needle.
  
  
  METHODS
  Area of CoNV.
  
  
  RESULTS
  Thirty patients underwent FND for CoNV that had not responded to treatment with topical steroids. The CoNV was associated with previous microbial keratitis (n = 26), intrastromal corneal ring segments (n = 2), ectodermal dysplasia (n = 1), and corneal choristoma (n = 1). Duration of CoNV was >6 months in 23 patients (77%), between 3 and 6 months in 3 patients (10%), and <3 months in 5 patients (13%). The number of afferent vessels per CoNV ranged from 1 to 3, with a mean diameter of 40 μm (standard deviation [SD], 10 μm) and mean time to leakage from apical vessels was 44.22 seconds (minimum, 27.43 seconds; maximum, 63.59 seconds). The number of FND treatments that were required was 1 for 20 patients (66.6%), 2 for 8 patients (26.6%), and 3 for 2 patients (6.6%). After FND, the area of CoNV reduced by 1.80 mm(2) (SD, 1.40 mm(2)), from 2.42 (SD, 1.59) to 0.62 mm(2) (SD, 0.73 mm(2)) up to 12 weeks postoperatively (P < 0.01).
  
  
  CONCLUSIONS
  The differentiation of afferent and efferent vessels using corneal angiography enables treatment to be selectively applied to the afferent vessels; there are usually 1 to 2 for each CoNV complex.
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. Electronic address: nax024@gmail.com.
authors.forename: Natasha
authors.initials: N
authors.lastname: Spiteri
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Vito
authors.initials: V
authors.lastname: Romano
authors.affiliation: Department of Eye and Vision Science, University of Liverpool, UK.
authors.forename: Yalin
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Sohraab
authors.initials: S
authors.lastname: Yadav
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Rahul
authors.initials: R
authors.lastname: Dwivedi
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Jern
authors.initials: J
authors.lastname: Chen
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Department of Eye and Vision Science, University of Liverpool, UK.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: Colin E
authors.initials: CE
authors.lastname: Willoughby
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Department of Eye and Vision Science, University of Liverpool, UK.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D003315:Cornea / Q000098:blood supply; D016510:Corneal Neovascularization / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003972:Diathermy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green