Peripapillary Choroidal Neovascularization

Abstract

Peripapillary choroidal neovascular membrane (CNVM) is a heterogenous description that encompasses CNVM due to various causes such as degenerative, inflammatory chorioretinal pathologies, and optic disc anomalies. Etiology is unidentifiable in a significant proportion, hence termed as idiopathic. In absence of a consensus definition, broadly speaking, any CNVM a part of which lies within one disc diameter of optic disc is considered as peripapillary CNVM. This differs from subfoveal CNVM in terms of location, proximity to optic disc, difference in etiologies, and visual prognosis. Clinical manifestations range from being asymptomatic to visual disturbances owing to subretinal hemorrhage, exudation, fluid, or extension of membrane to fovea. The diagnosis is established using fundus fluorescein angiography (occult or classic) and optical coherence tomography (type 1 or 2) depending upon the location of CNVM either in the subretinal pigment epithelial space or subretinal space. Current treatment options include anti-vascular endothelial growth factors (VEGF) as the first-line drug. Other options include laser photocoagulation and photodynamic therapy (PDT). Surgical management in the form of submacular surgery and macular translocation is not practiced nowadays. Conditions such as inflammatory chorioretinal disorders and optic disc pathologies (idiopathic intracranial hypertension, IIH) require treatment for the underlying disease pathology. Visual prognosis depends on the age, underlying disease pathology, proximity to fovea, and papillomacular bundle. Inflammatory and idiopathic variants, especially in young age carry a good prognosis whereas degenerative conditions such as age-related macular degeneration in elderly carry a worse prognosis.