Retinal and Choroidal Neovascularization
Retinal neovascularization is most often associated with posterior uveitis. Some diseases are more prone to be complicated by CNV (eg, as multifocal choroiditis, punctate inner choroiditis, or serpiginous choroiditis), whereas some are more likely to be complicated by retinal neovascularization (eg, retinal vasculitis of various causes, including Eales disease). Retinal neovascularization results from chronic inflammation or capillary nonperfusion. Treatment is directed toward the underlying etiology. The presence of uveitic retinal neovascularization does not always require panretinal photocoagulation. Some cases of sarcoid panuveitis, for example, may present with neovascularization of the disc that resolves completely with immunomodulatory and corticosteroid therapy alone. Thus, treatment must first be directed toward reduction of inflammation. If ischemia is angiographically extensive, as in retinal vasculitis or Eales disease, scatter laser photocoagulation in the ischemic areas is therapeutic. Dramatic regression of neovascularization of the disc and elsewhere in various inflammatory disorders typically occurs after 1 or 2 intravitreal injections of a VEGF inhibitor. This treatment may be used as an adjunct to IMT and scatter laser photocoagulation.
Choroidal neovascularization (CNV) can develop in uveitis as a result of a disruption of the Bruch membrane from choroidal inflammation and the presence of inflammatory cytokines that promote angiogenesis. The prevalence of CNV varies among different entities; for example, it can occur in up to 10% of patients with VKH syndrome. Patients present with metamorphopsia and scotoma, and diagnosis is based on clinical and angiographic findings. Treatment should be directed toward reducing inflammation as well as anatomical ablation of the CNV. Treatment of subfoveal CNV is accomplished with VEGF inhibitors; results of one study showed that 2–3 intravitreal injections improved vision and reduced the size of subfoveal CNV in nearly all patients. Control of inflammation in these cases may reduce the risk of recurrence of CNV and the need for repeated intravitreal injections.
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Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.