Peripapillary choroidal neovascularization in pars planitis

Abstract

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.

Bevacizumab (Avastin) and Thermal Laser Combination Therapy for Peripapillary Choroidal Neovascular Membranes

“…Peripapillary CNVM are also known to occur with other diseases including ocular histoplasmosis (OHS), angioid streaks, pars planitis, optic disc drusen, choroidal osteoma, and pattern dystrophies [1]. Peripapillary CNVM are predominately occult membranes and are often associated with retinal hemorrhage [2–4]. Some patients are asymptomatic and may be observed, while other patients present with decreased vision and metamorphopsia.…”

Diagnostic Challenges in Inflammatory Choroidal Neovascular Membranes

“…Rare instances of CNVM in intermediate uveitis have also been reported. 14,15 In our series, nearly all eyes had posterior or panuveitis, while only four eyes had intermediate uveitis. While tubercular uveitis was commonly associated with inflammatory CNVM in our series, MCP, ocular histoplasmosis, and PIC have been found to be common causes of inflammatory CNVM in a multicentric study.…”

A case of choroidal neovascular membrane in 6-year-old boy with juvenile idiopathic arthritis

“…Our findings of CNVM in a child with JIA may be explained with the concept that CNVM is driven at least in part by the intraocular inflammation. CNVM is relatively uncommon among patients with anterior and intermediate uveitis but not rare [ 6 , 12 ]. Breakdown of blood-retinal barrier and the role of several inflammatory and vasoactive peptides have been implicated as the cause of macular edema in JIA [ 13 ].…”

“…The prevalence of CNVM secondary to uveitis varies among different uveitic entities but is most commonly reported in patients with posterior uveitis and panuveitis [ 1 – 3 ]. CNVM in intermediate uveitis is relatively uncommon but has been reported in literature [ 4 – 6 ]. CNVM can occur as a result of any pathologic process that involves RPE and Bruch’s membrane [ 7 ].…”