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.