Mitomycin C-based angio-regression for corneal neovascularisation: outcomes with intravascular (MICE), intrastromal (MIST) and combined delivery routes.

BACKGROUND

Corneal neovascularisation (NV) is a refractory condition associated with lipid deposition, scarring and vision loss. Mitomycin C (MMC) intravascular chemoembolisation (MICE) has shown early promise but real-world data remain limited. This study evaluates the efficacy and safety of MICE and MMC intrastromal injection (MIST).

METHODS

Retrospective case series of patients with corneal NV treated with MICE and/or MIST at Moorfields Eye Hospital between March 2023 and March 2025. NV regression was assessed using (1) ImageJ quantitative analysis, (2) masked independent grading of slit-lamp photographs and (3) surgeon-reported outcomes. Corrected distance visual acuity and complications were recorded.

RESULTS

39 procedures were performed; median follow-up was 12 months. MIST alone was performed in 70% as intravascular cannulation was achieved in only 15%. NV regression was demonstrated in 59% by ImageJ analysis, 71% by independent grading and 81% by surgeon-reported outcomes. Four patients subsequently underwent successful keratoplasty without NV recurrence. Most complications were mild and self-limiting. Two serious complications involving anterior chamber MMC migration occurred in eyes with significant corneal thinning or prior perforation.

CONCLUSIONS

In the largest cohort reported to date, MICE and MIST represent effective angio-regressive strategies for refractory corneal NV. MIST alone produces meaningful vascular regression, offering a more accessible surgical approach. MMC-based angio-regression appears to be the most effective treatment currently available and may have an important role in stabilising high-risk corneas prior to keratoplasty.