• Retina/Vitreous

    Review of: Long-term analysis of clinical features and treatment outcomes of inflammatory choroidal neovascularization

    Kim M, Lee J, Park Y, et al. American Journal of Ophthalmology, July 2021

    Investigators reviewed records of patients treated with anti-VEGF for inflammatory choroidal neovascularization (CNV) to determine the long-term effects, particularly features seen on OCT.

    Study design

    This was a retrospective, interventional, consecutive case series of patients with a diagnosis of active inflammatory CNV who were treated at a single academic medical center in South Korea. Patients were given anti-VEGF therapy (primarily bevacizumab, although some patients were also given ranibizumab, aflibercept, or a combination of the agents), and were followed for at least 12 months afterwards with retinal imaging and examination.

    Outcomes

    About 2% of the 3615 patient cases had inflammatory CNV, per investigator review. Approximately half (46.2%) of this subgroup had subfoveal CNV, and the most common etiology was punctate inner choroidopathy or multifocal choroiditis. The mean logMAR best-corrected visual acuity improved from 0.49 ± 0.31 (Snellen equivalent: 20/63) at baseline to 0.21 ± 0.20 (Snellen equivalent: 20/32) following mean of 3.6 injections; a decrease in central macular thickness was also noted (295.1 ± 60.7 µm to 244.7 ± 37.8 µm). Of those with inflammatory CNV, 43.1% experienced a recurrence. The time interval from complete resolution to the next recurrence was 35.8 months. Intraretinal hyperreflectivity on OCT was the only anatomic imaging feature associated with recurrence (odds ratio 2.71).

    Limitations

    The trial lacked a control group of patients who did not receive anti-VEGF therapy for inflammatory CNV. In addition, some of the patients were on systemic steroids or steroid-sparing agents, and the confounding effects of this therapy on the outcomes of anti-VEGF treatment could not be excluded.

    Clinical significance

    Anti-VEGF therapy appears effective for patients with inflammatory CNV, with most patients experiencing improvement in visual acuity and corresponding anatomic improvements on retinal imaging with ≤4 intravitreal injections. However, patients should be monitored periodically for recurrence of CNV with exudation.