Functional Staging of Corneal Neovascularization Using Fluorescein and Indocyanine Green Angiography

PURPOSE: Corneal neovascularization (CoNV) is a major risk factor for corneal graft rejection and other corneal conditions. The maturity of CoNV is important to guide treatment. This study investigated associations between clinical and angiographic characteristics of CoNV. METHODS: In a prospective cross-sectional study patients with CoNV of variable but known duration and etiology were included. All cases were clinically staged according to a simplified three-grade scale as active, inactive, and regressed and assessed using color photography, anterior-segment optical coherence tomography, and fluorescein and indocyanine green (ICG) angiography. Outcome parameters included age and depth of CoNV, perfusion times and time to leakage of fluorescein and ICG. RESULTS: Forty eyes of 39 patients with CoNV were included, active (14), inactive (22), and regressed CoNV (4). There were significant associations between the time to fluorescein or ICG leakage and clinical staging of CoNV (R(2) = 0.24; P = 0.0011, and R(2) = 0.3; P = 0.0001). In addition, there was a significant association between the time to fluorescein leakage and the age of CoNV (R(2) = 0.32; P = 0.0002). ICG leakage within 10 minutes was observed significantly more frequently in active than the inactive group and was not observed in regressed cases (P < 0.0001). CONCLUSIONS: Simplification of the staging of CoNV to active, inactive, and regressed to is significantly associated with the time to extravascular leakage of fluorescein and indocyanine and may be useful to guide the selection of appropriate treatments. TRANSLATIONAL RELEVANCE: The association between clinical and angiographic characteristics of CoNV may provide guidance to the treatment approaches.