Risk of Choroidal Neovascularization among the Uveitides

Abstract

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.

Clinical Characteristics of Inflammatory Choroidal Neovascularization in a Chinese Population

“…30,31 Moreover, CNVs occur in more than one-tenth of VKH patients. 32 Sally et al 33 found a greater incidence of CNV in PIC, MCP, and VKH disease. Although PIC was not the most common uveitis, the natural history of this disease could be explained by the higher risk of developing CNV 34 : the lesion breaks through the RPE and subsequently disrupts Bruch's membrane in stage III, thereby facilitating CNV progression.…”

99Tc-MDP treatment for the therapy of rheumatoid arthritis, choroidal neovascularisation and Graves' ophthalmopathy

“…Its pathogenesis involves a disruption of the homeostasis between the retinal pigment epithelium and Bruch's membrane (20). The proliferating choroidal blood vessels extend into the macula region of the subretinal space, and leak fluid, leading to serous retinal detachment and scarring (20) and central vision loss.…”

Review of the latest local treatments for uveitis

“…The risk of CNV varies among different Review of the latest local treatments for uveitis Review informahealthcare.com uveitides and can be seen in presumed ocular histoplasmosis, punctate inner choroidopathy, multifocal choroiditis, serpiginous choroiditis and in Vogt-Koyanagi-Harada disease [67,68]. Lott et al evaluated the effect of 1.25 mg of intravitreal bevacizumab in 34 eyes of 30 patients with either inflammatory CNV (n = 21 eyes of 19 patients) or CME (n = 13 eyes of 11 patients) in a retrospective non-comparative interventional case series [69].…”