New Trends in the Management of Inflammatory Choroidal Neovascularisation

Abstract

Choroidal neovascularisation (CNV) can be a severe, sight-threatening sequela in patients with uveitis. CNV can occur in both infectious and non-infectious diseases. In the majority of cases, fluorescein angiography, indocyanine green angiography and optical coherence tomography allow the clinical characteristics of the CNV to be accurately determined. An infectious disease should be looked for so that patients can be given a suitable therapy when available. Regarding non-infectious inflammatory CNV, the treatment strategy should be aimed at controlling inflammation. Systemic corticosteroids with or without immunosuppressants are suggested, even when the CNV occurs with apparently inactive uveitis. In this case, chronic sub-clinical inflammation can be the basis for the CNV pathogenesis. Additional therapies aimed directly at the neovascular process, such as intravitreal antivascular endothelial growth factor agents, are recommended, particularly when the therapy shows insufficient efficacy. However, the current data are still only based on case reports or small series. For such reasons, further trials are mandatory to validate the preliminary results.

A 39-year-old woman with unilateral metamorphosias

“…1 Our patient underwent extensive evaluation to define the underlying etiology. Her work-up was negative for infectious and inflammatory conditions.…”

“…Punctate inner choroidopathy (PIC), multifocal choroiditis and panuveitis (MCP), and presumed ocular histoplasmosis syndrome (POHS) are the subtypes most frequently associated with choroidal neovascularization; however, any other form of posterior uveitis, for instance, acute posterior multifocal placoid pigment epitheliopathy, birdshot retinochoroidopathy, multiple evanescent white dot syndrome, Vogt-KoyanagiHarada syndrome, and sympathetic ophthalmia, can be complicated by choroidal neovascularization. 1 PIC is an idiopathic inflammatory disorder that typically occurs in young (15-55 years), white, myopic women. Presenting symptoms are blurred vision and scotomas with or without flashes of light.…”

“…1 MCP may be complicated by choroidal neovascularization in 32% to 46% of the patients. 1 Choroidal neovascularization can occur more frequently in inflamed areas, although it may originate from an old chorioretinal scar. 4 POHS is a bilateral immune reaction to an infectious agent, Histoplasma capsulatum, that affects the choroid and retina.…”

“…POHS is characterized by discrete atrophic choroidal scars in the macula and midperiphery associated with peripapillary atrophy and choroidal neovascularization-the classical triad of this disease. 1 This triad is accompanied by complete absence of any signs of anterior chamber or vitreal inflammation. Choroidal neovascularization is associated with inactive choroidal scars ("histo-spots"); they do not demonstrate active inflammation.…”

“…Choroidal neovascularization is associated with inactive choroidal scars ("histo-spots"); they do not demonstrate active inflammation. 1,4 The primary cause of visual impairment in POHS is the occurrence of choroidal neovascularization in the macula, which results in exudation and subsequent scarring. …”