Management of Choroidal Neovascularization in Uveitis

O'Toole, Louise; Tufail, Adnan; Pavésio, Carlos

doi:10.1097/01.iio.0000155902.49562.4a

Cited by 12 publications

(11 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This implies the proposition of CNV inactivation by means of maximum efficacy and avoidance of procedure-related risks. Photodynamic therapy using verteporfin in adults is a well-established and safe treatment for CNV related to various causes 4 7 13 20 – 25. Probably due to the overall low incidence of CNV in young patients, the efficacy and safety of PDT in paediatric or young adult patients have been subject to analysis in only a few reports so far 5 6 15.…”

mentioning

confidence: 99%

Photodynamic therapy with verteporfin in paediatric and young adult patients: long-term treatment results of choroidal neovascularisations

Lipski

Bornfeld

Jurklies

2008

British Journal of Ophthalmology

View full text Add to dashboard Cite

Background: Vision impairment in children and young adults may derive from choroidal neovascularisation (CNV) related to numerous conditions. The aim of this study is to highlight the applicability of photodynamic therapy using verteporfin (PDT) in these patients. Methods: In 16 eyes of 16 consecutive patients aged 30 years or younger, prospective open-label PDT was performed. Outcomes of visual acuity as well as changes in CNV lesion parameters were evaluated. Results: The mean patient age at first PDT was 19.7 (SD 8.7) years (range 6-30). 81% of the patients retained stable vision within two lines or exceedingly improved vision during follow-up of 34 (24) months. Significant vision gain was denoted in seven paediatric patients (2.7 (1.4) lines, mean (SD); p = 0.019) as well as in a subgroup of 12 patients not affected by active uveitis (2.6 (2.0) lines, p = 0.0005). Two patients with multifocal choroiditis and panuveitis (MCP) experienced vision losses of five and 11 lines after four PDT sessions despite receiving additional steroidal treatment. Except for one patient with MCP and two patients who dismissed followup, a mean of 2.2 (1.3) PDTs per patient sufficiently inactivated CNV lesions during follow-up. In the area of the former PDT spot, alterations of the pigment epithelium increased by 40% without correlation to changes in vision. Conclusions:The results indicate good PDT efficacy and tolerability most promising in a subgroup of patients with vision-impairing CNV not associated with active uveitis. PDT in young patients with CNV remains a valuable treatment with good risk-benefit profile over the long term.Choroidal neovascularisation (CNV) may develop in children and young adults due to pathological myopia, the presumed ocular histoplasmosis syndrome (POHS), retinochoroiditis as well as secondary to angioid streaks, trauma or idiopathically.

show abstract

mentioning

confidence: 99%

Photodynamic therapy with verteporfin in paediatric and young adult patients: long-term treatment results of choroidal neovascularisations

Lipski

Bornfeld

Jurklies

2008

British Journal of Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Several treatment options exist for peripapillary CNV in uveitis including vascular endothelial growth factor inhibitors, argon laser photocoagulation, and photodynamic therapy [10-13]. In the above cases, all patients underwent treatment with either argon laser photocoagulation or intravitreal bevacizumab (as used in our case) and did well with significant improvements in vision and CNV regression.…”

Section: Discussionmentioning

confidence: 82%

“…CNV has been reported to develop during times of quiescence or active inflammation [1,2]. Management with a vascular endothelial growth factor inhibitor likely is the treatment of choice, along with control of inflammation and control of any associated factors that may be present such as intracranial hypertension [13]. Based on the limited number of observations available, the prognosis of this condition with appropriate treatment appears favorable.…”

Section: Discussionmentioning

confidence: 99%

Peripapillary choroidal neovascularization in pars planitis

Mehta

Hariharan

et al. 2013

J Ophthal Inflamm Infect

View full text Add to dashboard Cite

BackgroundChoroidal neovascularization (CNV) is a rare complication of intermediate uveitis. Risk factors are not well-characterized. Here, we describe a case of peripapillary CNV in a patient with intermediate uveitis and explore the pathophysiology and treatment of this condition. This study is a case report and review of the literature.ResultsA 15-year-old boy with intermediate uveitis - suppressed for the preceding year on immunosuppressive therapy and low-dose corticosteroids - and chronic disc swelling presented with unilateral metamorphopsia, peripapillary subretinal hemorrhage, and subretinal fluid. Fluorescein angiogram confirmed the presence of an active choroidal neovascular membrane. Treatment with intravitreal bevacizumab 1.25 mg every 4 weeks for 4 months resulted in resolution of subretinal fluid, subretinal hemorrhage, and regression of the CNV. The patient's intermediate uveitis remained inactive throughout this time.ConclusionReview of the existing literature and pathophysiologic consideration suggests that chronic disc edema may be a risk factor for this condition. Peripapillary CNV in the context of intermediate uveitis appears to respond well to VEGF-inhibitor therapy.

show abstract

“…The salutary effects of anti-inflammatory and immunosuppressive agents for the treatment of CNV provides further support for an inflammatory contribution to pathogenesis. For example, in the pre-vascular endothelial growth factor (VEGF) inhibitor era, corticosteroids had been proposed as a first-line approach 18 based on their inhibitory action on inflammatory cells and subsequently the suppression of pro-angiogenic mediators, as well as their ability to decrease vascular permeability and prevent vascular budding 15, 18 . In addition, there has been some evidence suggesting that adding corticosteroids to photodynamic therapy (PDT) is more effective than PDT alone in inflammatory CNV 15 .…”

Section: Discussionmentioning

confidence: 99%

Risk of Choroidal Neovascularization among the Uveitides

Baxter

Pistilli

Pujari

et al. 2013

American Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases. Design Retrospective cohort study Methods Standardized medical record review at five tertiary centers. Results Among 15,137 uveitic eyes (8,868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4,041 eyes (2,307 patients) with posterior or panuveitis, 81 (2.0%) presented with CNV. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina/retinal pigment epithelium (RPE)/choroid interface. Among the 2,364 eyes (1,357 patients) with posterior or panuveitis and free of CNV at the time of cohort entry, the cumulative two-year incidence of CNV was 2.7% (95% confidence interval (95%CI): 1.8-3.5%). Risk factors for incident CNV included currently active inflammation (adjusted HR [aHR] 2.13, 95%CI: 1.26-3.60), preretinal neovascularization (aHR 3.19, 95%CI: 1.30-7.80), and prior diagnosis of CNV in the contralateral eye (aHR 5.79, 95%CI: 2.77-12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada Syndrome (aHR 3.37, 95%CI: 1.52-7.46), and punctate inner choroiditis (aHR 8.67, 95%CI: 2.83-26.54). Incident CNV was associated with two lines’ loss of visual acuity (+0.19 logMAR units, 95%CI: 0.079–0.29) from the preceding visit. Conclusions CNV is an uncommon complication of uveitis associated with visual impairment, which more commonly occurs in forms affecting the outer retina/RPE/choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.

show abstract

Management of Choroidal Neovascularization in Uveitis

Cited by 12 publications

References 72 publications

Photodynamic therapy with verteporfin in paediatric and young adult patients: long-term treatment results of choroidal neovascularisations

Photodynamic therapy with verteporfin in paediatric and young adult patients: long-term treatment results of choroidal neovascularisations

Peripapillary choroidal neovascularization in pars planitis

Risk of Choroidal Neovascularization among the Uveitides

Contact Info

Product

Resources

About