Imaging modalities for corneal neovascularization

Corneal neovascularization (CNV) is a frequent complication of many ocular surface diseases and represents a major threat to corneal transparency, visual function, and corneal graft survival. Accurate characterization, longitudinal monitoring, and assessment of treatment response require reliable and reproducible documentation. Numerous imaging modalities have been investigated for this purpose. Recent quantitative approaches incorporate morphometric parameters, the calculation of which has been facilitated by semi-automated or fully automated segmentation methods, increasingly supported by artificial intelligence. Slit-lamp photography remains the most widely accessible modality for CNV follow-up; however, its reliability and reproducibility are highly dependent on acquisition conditions. Anterior segment angiography using fluorescein and/or indocyanine green enables detailed anatomical analysis, but its invasive nature and technical complexity limit its routine clinical use. Optical coherence tomography angiography (OCT-A) represents a non-invasive alternative that allows three-dimensional visualization and quantitative analysis of CNV, with good correlation to conventional angiographic techniques. Nevertheless, current OCT-A systems are limited by a restricted field of view and the need for post-acquisition processing. Wide-field or full-field imaging systems facilitate acquisition and analysis and appear particularly promising. Similarly, infrared imaging, which is rapid and widely accessible, may contribute to improved standardization and automated image processing in the evaluation of CNV.