Idiopathic Choroidal Neovascularization

Almarek, Faisal; Alsulaiman, Sulaiman M.

doi:10.1007/978-981-15-2213-0_14

Cited by 3 publications

(5 citation statements)

References 46 publications

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“…In settings where no primary pathology can be identified, the condition is labeled as idiopathic CNV which is a rare occurrence. It is extremely rare for idiopathic CNV to occur in a previously normal pregnant female, which could be facilitated by the high levels of circulating VEGF, a state normal and essential for pregnancy [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Monis¹,

Ali²,

Bhutto³

et al. 2023

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

“…Myopia, traumatic rupture of the choroid, multifocal choroiditis, and histoplasmosis are among other common causes. CNV can complicate any pathological process and when no causative pathology can be identified, as in our case, the condition is labeled as idiopathic-CNV [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Monis¹,

Ali²,

Bhutto³

et al. 2023

Cureus

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“…Es ist extrem selten, dass eine idiopathische CNV bei einer zuvor gesundheitlich unauffälligen Schwangeren auftritt. Diese kann auf die hohe Konzentration an VEGF zurückzuführen sein, die in der Schwangerschaft normal und wichtig ist [1].…”

Section: Diskussionunclassified

“…Myopien, traumatische Rupturen der Aderhaut, multifokale Chorioiditis und Histoplasmose sind weitere häufige Ursachen. Die CNV kann pathologische Prozesse erschweren und wird – wenn wie in unserem Fall keine ursächliche Pathologie identifiziert werden kann – als idiopathische CNV bezeichnet [1].…”

Section: Introductionunclassified

Idiopathische choroidale Neovaskularisation in der Schwangerschaft: ein Fallbericht

Monis¹,

Ali²,

Bhutto³

et al. 2023

Kompass Ophthalmol

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Die choroidale Neovaskularisation (CNV) ist ein abnormes Gefäßwachstum vom choroidalen Gefäßsystem bis zur neurosensorischen Retina durch die Bruch’sche Membran und wird in der Regel mit einer «feuchten» altersbedingten Makuladegeneration (AMD) assoziiert. Andere Ursachen sind Myopien, traumatische Rupturen der Aderhaut, multifokale Chorioiditis und Histoplasmose. Die CNV ist eine der Hauptursachen für Sehverlust. Ihre Behandlung zielt darauf ab, den Fortschritt der Erkrankung zu stoppen und das Sehvermögen zu stabilisieren. Die intravitreale Injektion von Wirkstoffen gegen den vaskulären endothelialen Wachstumsfaktor (intravitreale Anti-VEGF-Injektion) ist die Behandlungsmethode der Wahl bei CNV, unabhängig von der Ätiologie. Der Einsatz dieser Methode in der Schwangerschaft ist aufgrund seines Wirkmechanismus und des Mangels an Sicherheitsnachweisen während der Schwangerschaft umstritten. In dieser Arbeit berichten wir von einer 27-jährigen Schwangeren, die seit 2 Wochen über verschwommenes Sehen und verminderte Sehkraft in ihrem linken Auge klagte. Bei der Untersuchung betrug ihr Sehvermögen ohne Hilfsmittel im rechten Auge 6/6 und im linken Auge 6/18 partiell ohne weitere Besserung. Basierend auf der Anamnese und der Untersuchung wurde sie mit einer idiopathischen CNV während der Schwangerschaft diagnostiziert, was weltweit erst der sechste gemeldete Fall war. Aufgrund der möglichen Nebenwirkungen auf den Fötus erklärte sich die Patientin trotz umfassender Beratung nicht mit einer Behandlung einverstanden. Ihr wurde zu regelmäßigen Nachuntersuchungen sowie zu einer sofortigen intravitrealen Anti-VEGF-Injektion nach der Geburt geraten. Um ein breiteres Verständnis für die Behandlungsprotokolle und -ergebnisse von intravitrealen Anti-VEGF-Injektionen in der Schwangerschaft zu erhalten, wurde eine Literaturrecherche durchgeführt. Dies half uns, ein Verständnis für die mögliche relative Sicherheit einer solchen Behandlung zu erhalten, wenn diese im Zuge eines multidisziplinären Ansatzes individuell angepasst wird.

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“…Choroidal neovascularization membrane (CNVM) is defined as the growth of new blood vessels that breach through the Bruch's membrane resulting in varied degrees of decrease or blurring of vision. Age-related macular degeneration is the most common predisposing cause for CNVM, but idiopathic CNVM cases have been noted in young individuals without any underlying cause, thus further complicating the clinical process, especially in pregnancy [1]. CNVM can lead to a decline in vision due to retinal deformation caused by fluid accumulation in subretinal spaces [2].…”

Section: Introductionmentioning

confidence: 99%

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

Mehdi

2024

Cureus

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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.

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Idiopathic Choroidal Neovascularization

Cited by 3 publications

References 46 publications

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Idiopathische choroidale Neovaskularisation in der Schwangerschaft: ein Fallbericht

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

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