Extensive Corneal Neovascularisation Treatment by Ultraviolet Corneal Collagen Crosslinking

Abstract

T he purpose of this article is to report a case of extensive corneal neovascularisation that was treated by ultraviolet corneal collagen crosslinking (CXL). The case report is about a 24-year-old man who was referred to the cornea clinic with a case of keratitis. He was treated with topical antibiotics. After full resolution of keratitis, his condition was complicated by extensive corneal neovascularisation. A trial of photochemical corneal collagen CXL with riboflavin/ultraviolet A resulted in a dramatic improvement and resolution of the corneal neovascularisation. Thus, we can conclude that corneal collagen CXL could be a promising procedure to treat certain cases of extensive corneal neovascularisation. KeywordsCorneal neovascularisation, collagen crosslinking, keratitis, riboflavin Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this case study.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Riboflavin/ultraviolet A (UVA) crosslinking (CXL) is a technique that was introduced several years ago for the treatment of keratectasia, keratoconus and infectious keratitis.2 Herein, we report a case of extensive corneal neovascularisation which was treated by ultraviolet corneal collagen CXL.Corneal collagen CXL could be an enormous hope in the treatment of corneal neovascularisation mentioning the limitations and undesirable side effects of the current treatment options for it. To our knowledge, this is the first report of using CXL to treat corneal neovascularisation. Case ReportA 24-year-old man without known previous medical illnesses; his past ocular history included left eye penetrating corneal trauma, treated with a rotational flap 7 years prior to presentation. The patient was treated for 2 weeks as a case of herpetic keratitis in a private clinic with oral acyclovir 800 mg five times daily, gatifloxacin 0.3% eye drops (E/D) every 2 hours (q2h) and atropine E/D q12h. There was no response to treatment and so was referred to our cornea clinic for further management.On examination, the patient visual acuity (VA) was 1.0 OD, hand motion OS. Slit lamp examination revealed normal right eye, while a left eye examination showed purulent discharge, severely injected conjunctiva, central corneal abscess, corneal neovascularisation and 1 mm hypopyon.Lens and posterior segment were invisible, so B-scan ultrasonography was performed and revealed a clear vi...