An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management

Abstract

Inflammatory choroidal neovascular membranes are challenging to diagnose and manage. A number of uveitic entities may be complicated by the development of choroidal neovascularization leading to a decrease in central visual acuity. In conditions such as punctate inner choroidopathy, development of choroidal neovascularization is extremely common and must be suspected in all cases. On the other hand, in patients with conditions such as serpiginous choroiditis, and multifocal choroiditis, it may be difficult to differentiate between inflammatory choroiditis lesions and choroidal neovascularization. Multimodal imaging analysis, including the recently introduced technology of optical coherence tomography angiography, greatly aid in the diagnosis and management of inflammatory choroidal neovascularization. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy.

Optical coherence tomography and optical coherence tomography angiography in uveitis: A review

“…In addition, active lesions exhibit signs of exudation such as subretinal fluid, subretinal hyper‐reflective material, retinal thickening, intraretinal cysts, and shadowing on the underlying structures. In contrast, inactive iCNVs appear as hyper‐reflective lesions with clearly marked edges and the absence of sub‐ or intraretinal fluid …”

“…Structural OCT is used as a routine imaging modality to diagnose iCNVs and to assess the activity of the neovascularization . In addition, OCTA findings can provide critical diagnostic differentiation between iCNVs and other inflammatory non‐neovascular lesions.…”

“…While multimodal imaging remains the gold standard approach to comprehensively investigate uveitic patients, combined OCT and OCTA are essential techniques for the detection and management of iCNVs. OCT allows a careful evaluation of the CNV activity and OCTA is extremely helpful in differentiating iCNVs from other non‐neovascular inflammatory lesions …”

“…Structural OCT is used as a routine imaging modality to diagnose iCNVs and to assess the activity of the neovascularization. 70 In addition, OCTA findings can provide critical diagnostic differentiation between iCNVs and other inflammatory non-neovascular lesions. Historically, the identification of iCNVs and inflammatory non-neovascular lesions was based on the use of invasive dye-based procedures such as fundus fluorescein angiography.…”

“…71 The majority of iCNVs are located above the RPE in the subretinal space, similar to the so-called type 2 or classic lesions of exudative age-related macular degeneration. 70 On structural OCT scans, an iCNV appears as an accumulation of hyper-reflective material seated between the disrupted RPE and the outer retinal layers, rarely accompanied by a sub-RPE component ( Figure 12A). 72 In addition, active In contrast, inactive iCNVs appear as hyper-reflective lesions with clearly marked edges and the absence of sub-or intraretinal fluid.…”