Peripapillary Neovascular Membrane in a Young Pregnant Woman and Prompt Response to Ranibizumab Injections following Uneventful Delivery

Abstract

Purpose: Occurrence of choroidal neovascularization (CNV) during pregnancy has been reported as a complication of presumed ocular histoplasmosis syndrome or punctuate inner chorioretinopathy. To our knowledge, idiopathic CNV (ICNV) during pregnancy has only been reported once in the relevant literature. Bevacizumab has been used for the treatment of ICNV in small case series. However, there is limited experience regarding the use of ranibizumab for the management of ICNV. Case Report: A 31-year-old woman in the eighth month of her second pregnancy was diagnosed with mild macular and papillary edema. She was followed up using biomicroscopy, fluorescein angiography (FA), and optical coherence tomography (OCT). After 3 months, visual acuity further deteriorated and funduscopy, FA and OCT findings revealed a juxtapapillary choroidal neovascular membrane (CNVM). After two ranibizumab injections, best-corrected visual acuity increased significantly, physiological macular anatomy was restored and no subretinal fluid was observed. Discussion: In this case report, we present a young pregnant patient with peripapillary ICNV and neurosensory detachment involving the macula, and treatment of the eye with intravitreal ranibizumab following uneventful delivery. Increased angiogenic factor levels associated with pregnancy may contribute to the onset of CNV although this relationship has to be investigated experimentally. The rapid response to ranibizumab suggests that this anti-VEGF agent may be an alternative treatment option in the management of peripapillary ICNV.

Observation and Clinical Pattern in Patients with White Dot Syndromes: The Role of Color Photography in Monitoring Ocular Changes in Long-Term Observation

“…The lesions healed spontaneously within 5 weeks. There have been single reports of choroidal neovascularization in pregnant women, observed in the course of presumed ocular histoplasmosis syndrome, inner punctate choroidopathy, or idiopathic disease [ 35 – 38 ].…”

Idiopathic choroidal neovascularisation in pregnancy: treatment options and a successful outcome

“…Only two cases of idiopathic CNV during pregnancy have been previously described 9 10. CNV has a complex aetiology, however, VEGF has an important role in its pathogenesis11 and serum VEGF levels have been demonstrated to be elevated during pregnancy12 which could potentially contribute to the development of CNV.…”

Idiopathic peripapillary subretinal neovascular membrane in a young woman with recurrence of the lesion during pregnancy after treatment with intravitreal bevacizumab

“…However, the role of ICG in the evaluation of the clinical characteristics of CNVM is now much less important since the introduction of anti-VEGF treatment. 7 Although there are two reports of idiopathic PSRNVM developing initially during pregnancy, 6 8 recurrences in pregnancy have not been reported. This is the first report of idiopathic PSRNVM recurrence during pregnancy.…”