Clinical evaluation and characterisation of corneal vascularisation.

BACKGROUND/AIMS: To clinically characterise corneal neovascularisation (CVas) with a view to elaborate clinical presentations and to standardise descriptors for clinical evaluation and research.

METHODS: Corneas of 165 patients with CVas due to a variety of corneal pathologies were observed clinically with the slit lamp biomicroscope and photography at different time points over the course of their disease. Parameters assessed included location, depth, length, branching pattern, colour, lipid leakage, nature of blood flow and presence of haemorrhage. A clinical grading of CVas was applied.

RESULTS: CVas can arise from the limbus, conjunctiva and iris. CVas preferentially travels along planes created by corneal incisions, suture tracks and lamellar keratoplasty, both deep lamellar and endothelial keratoplasty. CVas also principally follows the depth of pathology. CVas can be classified into active young, active old, mature, partially regressed and regressed. Herpetic infection was the most common cause of lipid keratopathy. Acanthamoeba keratitis induced the least amount of vascularisation. A simple and efficient clinical grading system for ascertaining the severity of CVas was developed and validated.

CONCLUSIONS: The various clinical characteristics of CVas described in this study can be used to standardise the nomenclature and description of CVas and clinically grade its severity. As modern, effective methods of treating CVas are being introduced, it is important that there is uniformity in the descriptors used to establish baseline values and evaluate outcomes of treatment. The parameters established in this study can help in this regard.