Intravitreal Dexamethasone Implant for the Management of Choroidal Neovascular Membrane in Pregnancy.

The management of choroidal neovascularization (CNVM) in pregnant young females has been a lacuna due to the rarity of the condition as well as the non-availability of comprehensive data to showcase the efficacy of currently available treatment regimes in order to achieve a positive outcome for both the growing fetus as well the patient herself. In a review of available literature, the condition has been treated with anti-vascular endothelial growth factors (anti-VEGF), laser photocoagulation, and intravitreal dexamethasone implants (IDI), with varied results ranging from the successful outcome in terms of pregnancy to abortions. When faced with such circumstances, healthcare professionals usually proceed cautiously, balancing the possible advantages against the hazards to the mother and the fetus. Here we present a case report of a young 30-year-old pregnant lady who developed idiopathic CNVM during her third month of gestation. Being a rare entity, CNVM in young pregnant women raises severe concerns due to potential consequences on the mother's and fetus's health. In certain previously documented cases, pregnant ladies with CNVM have been successfully treated with IDI. Hence, after much deliberation, we chose to go with IDI rather than anti-VEGF, which resulted in the successful management of her CNVM as well as achieving full-term normal delivery without any fetal anomalies. In this particular case, the pregnancy and the visual rehabilitation have both had favorable outcomes. There was no associated increased intraocular pressure (IOP) or changes to the lenticular structure. The literature review also suggests that IDI may still be as effective in managing CNVM during pregnancy, but at a lower risk than anti-VEGF drug. Even with the favorable outcomes revealed in case reports, larger-scale studies to properly examine IDI's safety profile would be required for regulatory clearance of its safety in pregnancy.

Efficacy and safety of intravitreal injections of conbercept for the treatment of idiopathic choroidal neovascularization.

BACKGROUND: To determine the efficacy and safety of intravitreally injected conbercept, a vascular endothelial growth factor receptor fusion protein, for the treatment of idiopathic choroidal neovascularization (ICNV). METHODS: This retrospective study analyzed outcomes in 40 patients (40 eyes) with ICNV who received intravitreal injections of conbercept 0.5 mg (0.05 ml) and were followed up for at least 12 months. All patients underwent full ophthalmic examinations, including best-corrected vision acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, color fundus photography, optical coherence tomography angiography, multifocal electroretinogram, and fundus fluorescence angiography, if necessary, at baseline and after 1, 3, 6, and 12 months. BCVA, macular central retinal thickness (CRT), IOP, CNV blood flow area, thickness of the CNV-pigment epithelial detachment complex, thickness of the retinal nerve fiber layer (RNFL), and the first positive peak (P1) amplitude density in ring 1 before and after treatment were compared. RESULTS: Mean baseline BCVA (logMAR), CRT, CNV blood flow area, and CNV-pigment epithelial detachment complex thickness were significantly lower 1, 3, 6, and 12 months after than before conbercept treatment (P < 0.05 each). IOP and baseline RNFL thickness were unaffected by conbercept treatment. P1 amplitude density was significantly higher 1, 3, 6, and 12 months after than before conbercept treatment (P < 0.05 each). None of the 40 eyes showed obvious ocular adverse reactions, such as endophthalmitis, glaucoma, cataract progression, and retinal detachment, and none of the patients experienced systemic adverse events, such as cardiovascular and cerebrovascular accidents. CONCLUSIONS: Intravitreal injection of conbercept is beneficial to eyes with ICNV, inducing the recovery of macular structure and function and improving BCVA, while not damaging the neuroretina. Intravitreal conbercept is safe and effective for the treatment of ICNV.

Hyperreflective material in patients with non-neovascular pachychoroid disease.

BACKGROUND: This study aimed to report eleven cases of non-neovascular pachychoroid disease with hyperreflective material (HRM) that occurred in Japanese patients. METHODS: A retrospective review of data from eleven patients who had non-neovascular retinal pigment epithelium (RPE) protrusion with HRM in the neurosensory retina between March 2017 and June 2022 was conducted. Clinical examination, color fundus photography, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), and OCT angiography data were analyzed. Main outcome measures were patient characteristics, changes in SD-OCT findings, and symptom outcomes. RESULTS: All cases had RPE protrusion and HRM with dilated choroidal veins, which were characteristic of pachychoroid disease. However, none of the cases had macular neovascularization (MNV). In 9 eyes (81.8%), HRM improved spontaneously without intervention and resulted in alterations in RPE, referred to as pachychoroid pigment epitheliopathy (PPE) or focal choroidal excavation (FCE). In these cases, symptoms such as metamorphopsia and distortion improved without treatment. In the remaining two cases (18.2%), HRM still persisted during the follow-up period. CONCLUSION: There are some cases of non-neovascular pachychoroid disorder with HRM, which might be a new entity of pachychoroid spectrum disease or an early stage of PPE or FCE. These cases should not be misdiagnosed as MNV, and careful observation is necessary.

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report.

Choroidal neovascularization (CNV) is the abnormal growth of vessels from the choroidal vasculature to the neurosensory retina through the Bruch's membrane and is usually associated with "wet" age-related macular degeneration (AMD). Other causes include myopia, traumatic rupture of the choroid, multifocal choroiditis, and histoplasmosis. CNV is a major cause of visual loss and treatment is aimed at halting progression and stabilizing vision. Intravitreal anti-vascular endothelial growth factor (IVT anti-VEGF) injection is the treatment of choice for CNV regardless of etiology. However, its use in pregnancy is debatable, due to its mechanism of action and lack of evidence of safety in pregnancy. Herein, we report a 27-year-old pregnant female, who complained of blurred and decreased vision in her left eye for two weeks. On examination, her unaided vision was 6/6 in her right eye and 6/18 partial in her left eye with no further improvement. Based on history, examination, and investigations she was diagnosed as a case of idiopathic CNV in pregnancy, being only the sixth reported case worldwide. Citing the risk of possible fetal adverse effects, the patient did not consent to the treatment despite extensive counseling. She was advised to follow up regularly and to receive IVT anti-VEGF injections immediately after delivery. A literature review was therefore undertaken to broaden our understanding of the treatment protocols and outcomes of using IVT anti-VEGF in pregnancy. This helped us to develop an understanding of the possible relative safety of such a treatment when individually tailored with a multi-disciplinary approach.

Imaging-based Biomarkers as Predictors of Response to Anti-VEGF Therapy in Idiopathic Choroidal Neovascularization.

PURPOSE: The purpose of this study was to identify biomarkers that predict the response of treatment-naive idiopathic choroidal neovascularization (iCNV) to anti-VEGF treatment. METHODS: Fourteen eyes diagnosed with iCNV underwent a dilated fundus examination, Swept Source Optical Coherence Tomography (SS-OCT) and Optical Coherence Tomography - Angiography (OCT-A), and were given an anti-VEGF injection. The same examinations were repeated at every follow-up visit. Analysis of the pre- and posttreatment images was done to identify possible biomarkers which were evaluated to check association with decreased need for multiple anti-VEGF injections. RESULTS: At presentation, 11 patients showed a compact pattern, while three patients showed an arborizing pattern on OCT angiography (P = 1). On follow-up imaging, seven patients showed a marked response, five patients showed a moderate response, and two patients showed a mild response to anti-VEGF injection. Among the seven patients showing a marked response, only one required a repeat injection (P = 0.03). On analysis of SS-OCT, a novel Retinal Pigment Epithelium (RPE) healing response was observed in posttreatment imaging of six patients (P = 0.59). CONCLUSION: A "marked" response to the first anti-VEGF injection results in a more sustained response and is a positive prognostic factor. RPE healing response is an interesting observation that merits further evaluation. Morphology of neovascular membranes has no effect on long-term need for multiple anti-VEGF injections.

Spectral domain-optical coherence tomography retinal biomarkers in choroidal neovascularization of multifocal choroiditis, myopic choroidal neovascularization, and idiopathic choroidal neovascularization.

OBJECTIVE: To use optical coherence tomography (OCT) to compare retinal biomarkers of choroidal neovascularization (CNV) secondary to multifocal choroiditis (MFC), myopic choroidal neovascularization (mCNV), and idiopathic choroidal neovascularization (ICNV) and to provide a basis for its clinical diagnosis and treatment. METHODS: In this retrospective case study, patients admitted to the Second Hospital of Hebei Medical University between January 2018 and January 2021 who were initially diagnosed with CNV secondary to MFC, mCNV, and ICNV were categorized into groups, by disease, for analysis. Spectral domain-OCT (SD-OCT) was used to describe and measure the morphological characteristics of CNV lesions in each group. The retinal biomarkers of CNV in MFC, mCNV, and ICNV were compared. RESULTS: Sixty-eight patients (71 eyes) were included and all eyes were diagnosed with active type 2 CNV. The MFC group had higher refraction than the ICNV group (P2 < 0.05). The choroidal thickness (CT) and CNV diameter of the MFC group were significantly greater than those of the mCNV group (P1 < 0.05). The number of eyes with sub-retinal fluids (SRF) and a "pitchfork sign" was significantly greater in the MFC group than in the mCNV group (P1 < 0.05). There was a significant difference only in CT) values between the MFC and ICNV groups (P2 < 0.001), but not in the other observation indicators (P2 > 0.05). CONCLUSIONS: OCT biomarkers, such as the diameter of the CNV, SRF, the "pitchfork sign," and CT under CNV are useful in distinguishing CNV secondary to MFC from mCNV, which can allow the timely selection of treatment in some difficult cases. There were no differences between the MFC group and ICNV group except in refractive error, which indicates that some ICNV cases may be an early stage of a type of occult chorioretinitis. Long-term follow-up is needed for ICNV patients to confirm whether there is any potential inflammation.Key messagesSometimes, it is difficult to separate MFC with CNV from myopic CNV and ICNV in clinical.OCT biomarkers, such as the diameter of the CNV, SRF, the "pitchfork sign," and CT under CNV are useful in distinguishing CNV secondary to MFC from mCNV.There were no differences between the MFC group and ICNV group except in refractive error.

Intravitreal Conbercept for Idiopathic Choroidal Neovascularization in Nursing Women.

Purpose: To report the clinical course and vascular endothelial growth factor (VEGF) levels in breast milk among three nursing women diagnosed with idiopathic choroidal neovascularization (CNV) before and after intravitreal injection of conbercept. Methods: This was an observational case series. The main outcomes and measures included best-corrected visual acuity (BCVA), anatomical features using optical coherence tomography, and breast milk concentrations of VEGF before and after the intravitreal injection of conbercept. Results: BCVA was increased, and no ocular or systemic safety problems were observed in any of the three patients during the follow-up period. An enzyme-linked immunosorbent assay was used to measure VEGF concentrations in the breast milk samples. Samples were collected 1 day before and 1, 7, and 30 days after the first intravitreal injection of conbercept. After conbercept injection, VEGF levels in breast milk were slightly decreased and did not change significantly in the following week; levels recovered fully by 30 days post-treatment. Conclusions: Intravitreal injection of conbercept shows favorable effectiveness and safety in the treatment of idiopathic CNV in nursing women and does not result in a significant reduction in VEGF in human breast milk.

Occult inflammation detected by autofluorescence May Be the cause of idiopathic choroidal neovascularization.

PURPOSE: To describe retinal pigment epithelium (RPE) disease detected by fundus autofluorescence (FAF) imaging in eyes with idiopathic choroidal neovascularization (ICNV). METHODS: A retrospective review of patients seen during a 14-month period with the diagnosis of ICNV was performed to identify patients with RPE disease, defined as hypo or hyperautofluorescent lesions on FAF. The presence of ICNV was confirmed by clinical history, ophthalmoscopic examination, fluorescein angiography (FA), and spectral domain-optical coherence tomography (SD-OCT). The clinical diagnosis of an underlying inflammatory condition was based on the FAF appearance of multiple punched-out hyper or hypoautofluorescent spots in the retinal fundus. RESULTS: The mean age was 27 years (range, 21-33 years). Best-corrected visual acuity ranged from 20/25 to 20/200 with a median visual acuity of 20/80. Ten eyes of 8 patients presented RPE abnormalities on FAF. Of the 10 study eyes, ICNV was observed in 8 eyes. ICNV appeared as a type 2 neovascular membrane at the macular area on FA, and SD-OCT revealed neurosensory detachment in all study eyes. FAF demonstrated abnormalities of the RPE that were not appreciated on clinical examination or by other imaging modalities. CONCLUSIONS: FAF may reveal an underlying inflammatory condition in patients diagnosed as ICNV, modifying the diagnosis and management.

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization.

BACKGROUND: This study aimed to evaluate the visual and morphological outcomes of intravitreal anti-VEGF therapy and the recurrence for idiopathic choroidal neovascularization (ICNV). METHODS: This retrospective study included 35 patients (35 eyes) with ICNV from July 2012 to October 2017. All patients received 1 intravitreal anti-VEGF injection followed by pro re nata injections until there was no sign of ICNV activity. This was defined as the first follow-up period. To evaluate ICNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest follow-up period was 5 years. Additional injection was performed when ICNV recurred. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded and morphological improvement in optical coherence tomography (OCT) was assessed. Parameters that affect prognosis and recurrence were analysed. RESULTS: The mean follow-up period was 168.0 ± 34.82 weeks. Mean BCVA improved from 56.20 ± 14.13 letters at baseline to 73.31 ± 12.57 letters (P<0.01); Mean CRT decreased from 353.6 ± 98.70 µm at baseline to 273.1 ± 53.56 µm (P < 0.001) at the end of the first follow-up period. Better baseline BCVA indicated a better morphological improvement (P = 0.026) in OCT: the lesion had completely subsided with recovery of the foveal contour. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions (P = 0.036). ICNV recurred in six patients (22.2%), 1 of whom experienced 2 recurrences. The mean timing of recurrence was 90.83 ± 49.02 weeks after diagnosis. There was no significant correlation between ICNV recurrence and the morphological improvement (P = 0.633). The final BCVA in patients with recurrence did not differ from that in patients without recurrence (P = 0.065). CONCLUSIONS: Intravitreal anti-VEGF therapy on a pro re nata basis was effective for treating ICNV. High baseline BCVA indicated a better prognosis. Re-treatment with anti-VEGF could effectively lead to resolution of recurrent ICNV. Disease recurrence had no significant effect on final visual prognosis and had no correlation with the morphological improvement during treatment, suggesting that follow-up for subsequent monitoring should be performed in all ICNV patients.

Results of Intravitreal Anti-VEGF Injection in Choroidal Neovascularization Caused by Pathologies Other Than Age-Related Macular Degeneration.

OBJECTIVES: The aim of this retrospective study was to evaluate the efficacy of the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents to treat choroidal neovascularization (CNV) caused by a pathology other than exudative type age-related macular degeneration (AMD). METHODS: This was a retrospective study of 43 treatment naive eyes of 35 patients who had been diagnosed with CNV caused by a pathology other than exudative- type AMD and who underwent intravitreal injection of anti-VEGF agents. Primary and secondary outcome measures were the best corrected visual acuity (BCVA) and the central macular thickness (CMT). RESULTS: The mean patient age was 44.6±13.1 years. The mean number of injections was 3.3±1.8. The mean logarithm of minimal angle of resolution BCVA at baseline and the 12th month follow-up was 0.89±0.50 and 0.73±0.57, respectively (p=0.120). In all, 44.2% of the eyes gained ≥15 letters of BCVA, whereas 14% lost ≥15 letters of BCVA. The mean CMT at baseline and the 12th month follow-up was 381±121 and 311±73 microns, respectively (p=0.001). CONCLUSION: Stabilized functional and improved anatomic outcomes following intravitreal anti-VEGF agent injection for CNV unrelated to AMD were seen at the 12th month of follow-up.

Long-Term Efficacy of Intravitreal Conbercept Injection in the Treatment of Idiopathic Choroidal Neovascularization.

Purpose: To investigate the long-term efficacy of intravitreal conbercept injection in treating idiopathic choroidal neovascularization (CNV). Methods: In this longitudinal retrospective cohort study, 27 eyes (27 patients) with idiopathic CNV receiving conbercept intravitreously (0.5 mg/0.05 mL) with 1+PRN regimen were included. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) at the baseline and the end of follow-up were compared, respectively. The number of injections and recurrence time were evaluated. Results: Of the 27 patients, 7 were men and 20 were women. Their mean age at diagnosis was 31.37 ± 7.35 (16-46) years. The follow-up period was 44.59 ± 8.60 (27-58) months. The mean initial injection number was 1.22 ± 0.42, and 1.67 ± 1.04 injections were administered throughout the follow-up. Seven patients experienced CNV relapse, with 1 episode in 4 patients, 2 episodes in 2 patients, and 5 episodes in 1 patient. LogMAR BCVA changed from 0.77 ± 0.19 at baseline to 0.09 ± 0.10 at the final visit, and CRT decreased from 343 ± 73.5 µm to 172.41 ± 30.82 µm. Both BCVA improvement and CRT reduction were statistically significant (P < 0.001). No ocular or systemic complications occurred. Conclusions: Intravitreal injection of conbercept shows favorable effectiveness in the treatment of idiopathic CNV during a long-term period of follow-up.

Genetic factors for idiopathic choroidal neovascularization.

Objective: The aim of this study was to investigate genetic factors associated with idiopathic choroidal neovascularization (ICNV). Methods: We conducted a case-control study including 69 cases with ICNV and 114 controls who underwent cataract surgery. Single nucleotide polymorphisms (SNPs) from genes reported to be related to AMD, CNV and uveitis were selected for this study. Results: In an univariate analysis, the rs669676 SNP located in the COL8A1 gene was associated with the proportion of people who has idiopathic CNV ( X2 = 9.3453, corrected p-value = 0.1). For the rs669676 SNP, minor allele homozygotes, in the dominant model of genotype analysis (GG versus AA-GA), it showed significant differences in the ICNV group vs controls (p = .01, OR = 1.219 (95%CI: 1.04-1.429)). Conclusions: The rs669676 SNP located in the COL8A1 gene may contribute to a genetic susceptibility for ICNV.

Cytokine profiling reveals increased serum inflammatory cytokines in idiopathic choroidal neovascularization.

BACKGROUND: The exact pathogenesis of idiopathic choroidal neovascularization (ICNV) remains unclear. Cytokine-mediated inflammation has been thought to be involved in the pathophysiology of ICNV. The purpose of this study was to investigate serum cytokine profiles in patients with ICNV and to explore the relationship between serum cytokine levels and ICNV severity. METHODS: This case-control study was conducted in 32 ICNV patients and 30 healthy volunteers. Clinical and demographic information was obtained from the medical data platform and the serum was analysed with a multiplex assay to determine the levels of seven cytokines: interleukin (IL)-2, IL-10, IL-15, IL-17, basic fibroblast growth factor (basic FGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and vascular endothelial growth factor (VEGF). RESULTS: Serum levels of IL-2, IL-10, IL-17, basic FGF, and VEGF were elevated in ICNV patients compared to controls. Serum GM-CSF levels were positively related to central retinal thickness, and serum IL-17 levels were positively related to CNV lesion area. CONCLUSION: Serum inflammatory cytokines were significantly elevated in ICNV patients compared to controls. This suggests that systemic inflammation may play a critical role in the physiopathology of ICNV.

Long-term efficacy of intravitreal ranibizumab therapy for idiopathic choroidal neovascularization / 中华实验眼科杂志

Objective To observe the long-term clinical efficacy of intravitreal ranibizumab (IVR) in patients with idiopathic choroidal neovascularization (ICNV),and to explore the indicators that affect curative effect.Methods A retrospective self-controlled study was performed.The clinical data of 61 ICNV patients (61 eyes) from January 2013 to May 2014 in the First Affiliated Hospital of Xi'an Jiaotong University were Collected.The best corrected visual acuity (BCVA),the central retinal thickness (CRT),the height of pigment epithelium detachment (PED) and the defect length of ellipsoidal zone (EZ) before and after treatment were analyzed,the baseline clinical indicators were compared among different IVR treatment times and ICNV types.Results The mean follow-up time was (41.5±4.6) months.The mean BCVA (LogMAR) were 0.59±0.32 and 0.17 ± 0.12,the mean CRT were (331.18±80.42) μm and (245.07±44.67) μm,the mean height of PED were (246.73±104.75) μm and (205.78±117.01) μm and the mean defect length of EZ were (2 315.10± 1 233.77) μm and (1 325.98± 1 157.30) μm before and after treatment,respectively,with significant differences between before and after treatment (all at P＜0.05).Fifty-three patients (86.89％) completed the treatment in the first year or within three times.The mean CRT and the height of PED in the IVR ≥ 3 times treatment group were significantly higher than those in the IVR 1 times treatment group (all at P＜0.05).There was no significant difference in the average treatment times among inferior lateral of macular fovea,side of macular fovea and outside of macular fovea (F =1.982,P ＞ 0.05).Conclusions IVR therapy for ICNV is well tolerated with an improvement in BCVA,CRT,height of PED and defect length of EZ.The majority of patients can complete the treatment within 1 year,and most patients can be cured within 3 times treatments.The number of treatments may be associated with the CRT and the height of PED at baseline.

Clinical characteristics and antivascular endothelial growth factor effect of choroidal neovascularization in younger patients in Taiwan.

BACKGROUND/PURPOSE: The purpose of this study is to share experiences diagnosing and treating choroidal neovascularization (CNV) in young patients (age ≤ 50 years) at our hospital. METHODS: The study reviewed retrospective data of patients (≤ 50 years old) with CNV who received antivascular endothelial growth factor treatment (anti-VEGF) between January 2007 and August 2012 at Shin Kong Wu Ho-Su Memorial Hospital. We recorded the total number of injections, types of drugs, preoperative and final best-corrected visual acuity (BCVA), central retinal thickness (CRT) in optical coherence tomography (OCT), and total follow-up times, and then used two-tailed paired t tests to compare mean changes in BCVA and CRT on OCT. RESULTS: The study enrolled 59 patients ≤ 50 years of age with CNV diagnosed in 67 eyes. The mean age was 36.9 ± 10.0 years (range, 8-50 years). Twenty-one patients were male and 38 patients were female. Forty-two CNV lesions were subfoveal, 19 were juxtafoveal, and five were extrafoveal. The mean total follow-up time was 18.5 ± 19.9 months (range, 0.5-71 months). Pathologic myopia was the most common cause of CNV in this study (47.8%), followed by punctate inner choroidopathy (17.9%), idiopathic CNV (16.4%), polypoidal choroidal vasculopathy (13.4%), angioid streaks (3.0%), and choroidal rupture (1.5%). After anti-VEGF treatment, the mean BCVA improved from 0.69 ± 0.61 to 0.42 ± 0.59 (p < 0.05). CRT decreased from 257.5 ± 48.2 to 210.3 ± 35.7 (p < 0.05). The mean number of injections was 1.9 ± 1.6 (range, 1-9). CONCLUSION: In this study we found that pathologic myopia, punctate inner choroidopathy, and idiopathic and polypoidal choroidal vasculopathy comprised the four most common causes of CNV in patients ≤ 50 years of age in Taiwan. We also revealed that anti-VEGF treatment is highly effective in the treatment of CNV in this age group.

Neovascularización Coroidea Idiopática y Terapia Antiangiogénica con Recuperación Total de Agudeza Visual: reporte de caso / Idiopathic Choroidal Neovascularization and Antiangiogenic Therapy with Full Recovery of Visual Acuity: case report

Objetivo: presentar el caso de un paciente joven con neovascularización coroidea idiopática, con importante compromiso visual unilateral y que con la inyección intravítrea de aflibercept mensual, por tres meses, recuperó completamente la agudeza visual. Diseño: reporte de caso. Método: se realizó un estudio descriptivo tipo reporte de caso, mediante la recopilación de datos clínicos, estudios imagenológicos y valoraciones postoperatorias. Resultados: mejoría significativa de agudeza visual en paciente con neovascularización coroidea idiopática en ojo izquierdo posterior a tres inyecciones intravítreas de aflibercept mensual. El paciente mejoró de 20/400 a 20/20 al completar el esquema terapéutico. Conclusiones: el esquema de antiangiogénico resultó ser útil para el tratamiento de neovascularización coroidea idiopática en un paciente joven, logrando una recuperación visual y anatómica completa.

Objective: to present the case of a young patient with idiopathic choroidal neovascularization, with significant unilateral visual impairment. He fully recovered visual acuity by appliyng monthly intravitreal aflibercept, for three months. Design: case report. Method: a descriptive, case report study type was performed by collecting clinical data, imaging studies and postoperative evaluations. Results: Significant visual acuity improvement was obtained in the present patient with idiopathic choroidal neovascularization after three monthly intravitreal injections of aflibercept. The patient improved from 20/400 to 20/20 when treatment was completed. Conclusions: antiangiogenic schemev could be useful for the treatment of idiopathic choroidal neovascularization, achieving a complete visual and anatomical recovery.

Intravitreal bevacizumab as a primary treatment for idiopathic choroidal neovascularization.

PURPOSE: To report long-term outcomes of the use of intravitreal bevacizumab in subjects with idiopathic choroidal neovascularization (ICNV). MATERIALS AND METHODS: Six consecutive subjects with ICNV were included in this prospective study. All subjects received 1.25 mg intravitreal bevacizumab at diagnosis. A decrease in best corrected visual acuity (BCVA), presence of increased retinal edema or hemorrhage, increased retinal thickness on optical coherence tomography (OCT) or increased leakage documented by fluorescein angiography prompted further injections of bevacizumab. RESULTS: The study cohort was comprised of 3 males and 3 females with a mean age of 31.17 years. Mean follow-up was 13.8 months (range, 8 months to 20 months). Following intravitreal bevacizumab injection, vision improved in 3 subjects, remained stable in 3 subjects and no patient lost visual acuity. The mean BCVA improved to logMAR 0.20 at final follow-up from baseline at 0.950 logMAR (P=0.031). The mean central macular thickness and central foveal thickness at the last postoperative visits were reduced from pre-treatment levels of 374.33 ± 146.52 and 347.16 ± 213.97 to 251.20±35.36 and 215.33 ± 43.94 µm, respectively. (P = 0.99 and P = 0.16, respectively). Four subjects required repeat treatments. The total number of repeat treatments was 4. Two subjects required no repeat injections, 3 subjects had 1 retreatment and one subject required 2 additional treatments. The injections were well tolerated by all the subjects, with no ocular or systemic adverse events. CONCLUSION: Intravitreal injection of 1.25 mg bevacizumab in patients with ICNV is effective in improving and stabilizing vision. Additional studies, particularly determination of optimal protocol for timing of re-injection are required to assess long-term effects.

The treatment of central exudative chorioretinopathy / 中华实验眼科杂志

Central exudative chorioretinopathy( CEC),also known as idiopathic choroidal neovascularization (ICN),was more common in middle-aged,appearing the isolated macular choroidal neovascularization lesions ( CNV ).CNV can cause macular hemorrhage,exudativeing and scarring and therefore affect the patient' s central vision.The etiology of CEC is below understanding,and the treatment aimed at CNV.The clinical management of CEC include photodynamic therapy ( PDT),the administration of antibody of vascular epithelial growth factor ( VEGF ),adrenal glucocorticoid drug,combined therapy,transpupillary thermotherapy (TTT),laser photocoagulation,ratiotherapy,surgery,Chinese traditional medicine and gene therapy.The various treating approaches and their mechanisms were reviewed.

Idiopathic choroidal neovascularisation as the inaugural sign of multiple evanescent white dot syndrome.

We report a case of multiple evanescent white dot syndrome (MEWDS) that presented with putative idiopathic choroidal neovascularisation (ICNV) before showing angiographic signs typical of MEWDS. A 16-year-old male presented with unilateral metamorphopsias and visual loss in his left eye. ICNV with subretinal hemorrhage was diagnosed and treated with intravitreal Avastin(®). Fifteen days later, regression of choriodal neovascularization (CNV) was documented together with the appearance of fluorescein angiography (FA) and indocyanine green angiography (ICGA) signs typical for MEWDS, that included faint mottled FA hyperfluorescence in the mid-peripheral fundus, irregularly shaped mid-peripheral ICGA dark areas in the intermediate angiographic phase that were clearly delineated in the late phase as well as peripapillary hypofluorescence. Fundus examination appeared completely normal during the follow-up except for the CNV hemorrhage noted at the initial visit. This case demonstrates the need to consider ICNV as a diagnosis of exclusion until inflammatory causes have been eliminated. In this case, the underlying occult inflammatory condition would have been missed without the ICGA data that clearly showed signs of MEWDS that was supported by FA findings.

Long-term Natural Course of Idiopathic Choroidal Neovascularization

PURPOSE: To evaluate the correlation between lesional variation and visual outcome and natural course of idiopathic choroidal neovascularization (CNV) in the patient who had been treated with conservative treatment only. METHODS: Best corrected visual acuity (BCVA), fluorescein and indocyanine angiographic examination (FAG and ICGA) and comparative analyses were performed for twenty eyes diagnosed with subfoveal and juxtafoveal idiopathic CNV and the long-term (mean, 24.7 months) natural course was followed. RESULTS: Juxtafoveal CNV occurred in 12 eyes (60%) and final BCVA in 17 eyes (85%) improved over 1 line or remained unchanged. Minimal or no leakage of final FAG was shown in 12 eyes (60%). In final ICGA, dark rim was found in 16 eyes (80%), hyperfluorescent area in 12 (60%) and focal choroidal venous dilatation in 3 (15%). Juxtafoveal CNV had more favorable visual outcome than subfoveal CNV and the increased dark rim and decreased hyperfluorescent area in ICGA were significantly correlated with favorable visual outcome. CONCLUSIONS: Idiopathic CNV had a favorable visual outcome during long-term follow-up period with conservative treatment only.