Inflammatory Choroidal Neovascular Membrane Research Articles

Role of optical coherence tomography angiography in diagnosis and management of inflammatory choroidal neovascular membrane in multifocal choroiditis – A case report

A 32-year-old male presented with decreased vision in the left eye. Fundus examination revealed healed multifocal choroiditis (MFC) and a juxtafoveal subretinal bleed. Optical coherence tomography (OCT) revealed streak subretinal fluid (SRF) and subretinal hyperreflective material (SHRM) at the macula. Fluorescein angiography (FA) showed a small area of faint hyperfluorescence adjacent to a choroiditis scar, amidst background scarring. Optical coherence tomography angiography (OCTA) detected type 2 choroidal neovascular membrane (CNV). A detailed clinical examination with appropriate ancillary imaging helps in detection of inflammatory CNV. OCTA may be superior to FA in detection of these neovascular membranes in certain case scenarios.

Tuberculosis reactivation demonstrated by choroiditis and inflammatory choroidal neovascular membrane in a patient treated with immune checkpoint inhibitors for malignant mucosal melanoma

PurposeTo describe a complex case of ocular tuberculosis reactivation with anterior uveitis, choroiditis and inflammatory choroidal neovascular membrane (CNVM) following immune checkpoint inhibitor (ICPI) treatment of malignant mucosal melanoma.MethodsA retrospective collection of medical history, clinical findings and multimodal imaging with literature review of the topic was conducted.ResultsA 52-year-old Romanian female developed reduced vision and photophobia after three cycles of ICPI therapy comprised of ipilimumab and nivolumab. Bilateral anterior uveitis, multiple left eye choroidal lesions and a CNVM were confirmed using slit-lamp examination with ancillary multimodal imaging. Retinal changes in the right eye as well as a history of previously treated posterior uveitis and high-risk ethnicity increased clinical suspicion for ocular tuberculosis (TB) reactivation. The diagnosis was confirmed by TB positivity on polymerase chain reaction (PCR) analysis of lung aspirate followed by significant clinical improvement on systemic anti-tubercular therapy (ATT), systemic steroids and anti-vascular endothelial growth factor (VEGF) therapy.ConclusionsICPIs can cause a myriad of ocular issues, both by primary immunomodulatory effects as well as secondary reactivation of latent disease.

Preretinal exudates in ocular tuberculosis

Preretinal exudates have been described in various ocular diseases. We present a case of preretinal exudates in tubercular retinal vasculitis with an inflammatory choroidal neovascular membrane (CNVM). The patient was treated with a tapering dose of oral corticosteroids, antitubercular therapy. Inflammatory CNVM which develops in active disease or during regression can be treated with intravitreal bevacizumab. In our case, the resolution of exudates was seen within 8 weeks of starting the treatment without any scar formation. In conclusion, we report a picture of exudates in a novel plane (preretinal) concerning tubercular vasculitis.

Inflammatory choroidal neovascularization associated with immunoglobulin G4-related disease: a case report

BackgroundImmunoglobulin G4-related disease is a recently recognized condition with pathologic features that are consistent across a wide range of organ systems. Orbital manifestations of this disease entity typically involve the lacrimal gland and lacrimal duct, extraocular muscles, orbital soft tissue, and sclera. Here, the authors report the first known case of inflammatory choroidal neovascular membrane associated with immunoglobulin G4-related disease and offer suggestions for clinical management of this enigmatic condition.Case presentationA 38-year-old Caucasian man with a history of recurrent tonsillitis presented with blurry vision in his left eye of 1-week duration and was diagnosed as having inflammatory choroidal neovascular membrane. An infectious workup was negative, but his serum immunoglobulin G4 level was elevated at 248 mg/dL (reference 4–86), and a subsequent tonsillectomy for a repeat episode of tonsillitis revealed increased immunoglobulin G4 staining on histopathology, thus confirming the diagnosis of immunoglobulin G4-related disease. The inflammatory choroidal neovascular membrane was treated with intravitreal bevacizumab injections and orally administered prednisone resulting in improved visual acuity and choroidal neovascular membrane regression. He later received rituximab infusions for immunoglobulin G4-related disease.ConclusionsWe report a case of choroidal neovascularization associated with immunoglobulin G4-related disease, a chronic inflammatory condition whose ophthalmic manifestations typically include dacryoadenitis, orbital myositis, or scleritis. This is the first reported instance of inflammatory choroidal neovascular membrane associated with immunoglobulin G4-related disease. Early detection of this disease is important to avoid organ damage and potential complications, so clinicians should maintain an index of suspicion for this condition when inflammatory choroidal neovascular membrane is observed.

Intra and inter-rater agreement of inflammatory choroidal neovascular membrane measurements using optical coherence tomography angiography.

Automated measurement algorithm software is not routinely available in optical coherence tomography angiography (OCTA) devices and manual measurement of choroidal neovascular membrane (CNVM) size is necessary. Our aim was to determine intra- and inter-rater agreement of inflammatory CNVM manual measurements obtained with OCTA. OCTA (Triton® Topcon Corporation) images in patients with inflammatory CNVM were imported into ImageJ software v1.50 (NIH image). Two experienced observers performed manual area and perimeter measurements independently, and one of the observers performed the same measurements twice. Agreement was evaluated with intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). Bland-Altman plots were plotted to graphically assess concordance. Statistical analysis was performed using STATA v13.0. Sixteen eyes of 16 subjects, with a mean age of 39.0 ± 16.6 years (range 13-71), were included. Mean CNVM area and perimeter was 124.83 ± 117.80 and 4.20 ± 2.00 mm, respectively. Intra-rater ICC for both area and perimeter measured was 0.99 (95% confidence interval (CI) 0.99-0.99). Inter-rater ICC for area and perimeter measured was 0.95 (95%CI 0.87-0.98) and 0.81 (95%CI 0.17-0.94), respectively. Intra-rater CCC for both area and perimeter measured was 0.99 (95%CI 0.99-0.99). Inter-rater CCC for both area and perimeter measured was 0.91 (95%CI 0.81-0.99) and 0.66 (95%CI 0.44-0.88), respectively. Inflammatory CNVM manual measurement showed high intra-rater agreement and moderate inter-rater agreement. Repeatability and reproducibility studies are essential in manual analysis to establish thresholds that can distinguish measurements variation from true clinical change. An automatic algorithm may be helpful to accurately grade lesions and monitor disease activity and response to treatment.

INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANE: Long-Term Visual and Anatomical Outcomes After Intravitreal Anti-vascular Endothelial Growth Factor Therapy.

To assess the long-term visual and anatomical outcomes after intravitreal anti-vascular endothelial growth factor therapy for inflammatory choroidal neovascular membrane (CNVM). Retrospective case series of 15 consecutive cases of newly diagnosed inflammatory CNVM who were treated with intravitreal bevacizumab or ranibizumab injections. The study included 8 women and 7 men with mean age at presentation with CNVM of 40.53 ± 17.46 years (range, 11-70 years), and mean follow-up duration after anti-vascular endothelial growth factor therapy was 20.53 ± 14.53 months (range, 6-48 months). All eyes had classic CNVM confirmed by fluorescein angiography, most commonly located in the peripapillary area (8 eyes, 53.3%), followed by juxtafoveal (4 eyes, 26.7%), and subfoveal location (3 eyes, 20%). All CNVMs showed complete resolution with mean 2.6 ± 1.2 injections per eye. Preinjection mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.79 ± 0.76 (approximate Snellen equivalent 20/123) and mean central macular thickness of 435.9 ± 190.2 μm improved significantly to mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.46 ± 0.43 (approximate Snellen equivalent 20/58) and mean central macular thickness of 262.13 ± 108.70 μm (P value 0.02 and <0.0001, respectively) at the final visit. Recurrence was seen in 26.7% eyes (4/15), all of which regressed with single injection. Only complication noted was subretinal fibrosis in one eye (6.7%). For inflammatory CNVM, in addition to immunosuppression in cases with active inflammation, anti-vascular endothelial growth factor therapy seems as a very effective treatment modality resulting in significant visual improvement and foveal flattening. Incidence of major complications is rare, and the recurrence rate seems low.

Intravitreal ranibizumab for the treatment of choroidal neovascularization secondary to ocular toxoplasmosis

Dear Editor, We read the article by Shah et al.[1] with great interest. At first, we would like to congratulate the authors for a very nice case reported here. We have a few comments to make on this case report. Inflammatory choroidal neovascular membrane (CNVM) is not so uncommon to be seen as reported in the case and it may be associated with toxoplasmosis, tuberculosis, etc.[2,3] Subretinal fluid (SRF) mentioned in Fig. 1 (color picture) is not very well supported by Fig. 2 where optical coherence tomography (OCT) does not show any SRF. Instead, it does show scarring. Blocked fluorescence seen in Fig. 2 may be due to the pigmentation around the lesion which may be a sign of longstanding lesion with retinal pigment epithelium (RPE) alteration. Hyperfluorescence seen in Fig. 2 may be staining of scar as it is a late phase angiogram picture. No early phase picture is shown in the support of early leak of CNVM. Fig. 3 is shown in the article as no leak with regressed CNVM, which is an early phase picture and it may take stain in late phase as in Fig. 2 if it was only scar. It is well supported by the OCT showing shadowing of the reflectivity behind the scar. Both the OCTs shown in Figs. 2 and 3 are probably not passing through the same place, so we cannot compare the reflectivity and shadowing of these two pictures.

Resolution of vitreomacular traction following intravitreal ranibizumab in cases of ocular toxoplasmosis with choroidal neovascularization

PurposeTo present the occurrence of the resolution of vitreomacular traction following intravitreal ranibizumab in two patients with inflammatory choroidal neovascular (CNV) membrane with a background of ocular toxoplasmosis.MethodsInterventional case report.ResultsA 21-year-old Caucasian woman and a 52-year-old Caucasian man both presented with vitreomacular traction with coexistent classic CNV membrane and a background of ocular toxoplasmosis. They both received an intravitreal injection of ranibizumab in an effort to control the underlying CNV membrane. A resolution of the vitreomacular traction was observed within 1 week of the intravitreal injection in both cases.ConclusionTo the best of our knowledge, this is the first reported case of vitreomacular traction resolution in two patients with ocular toxoplasmosis following ranibizumab administration. Of course, further studies are needed in order to adequately support this association.

Management of recurrent inflammatory choroidal neovascular membrane secondary to Vogt-Koyanagi-Harada syndrome, using combined intravitreal injection of bevacizumab and triamcinolone acetate

The purpose of this report is to evaluate the efficacy and safety of combined intravitreal injection of bevacizumab and intravitreal triamcinolone acetonide (IVTA) for recurrent inflammatory choroidal neovascular membrane (CNVM). It was a prospective interventional study of a young female, who was a known case of Vogt-Koyanagi-Harada syndrome. She presented with an inflammatory choroidal neovascualar membrane and signs of panuveitis in the right eye. She underwent a complete ophthalmic examination. She was given intravitreal injection of bevacizumab and IVTA at different sites. There was complete regression of CNVM and ocular inflammation within a week. After six months, she had recurrence of CNVM in the same eye, which was treated similarly. There was a complete resolution of CNVM and ocular inflammation after the combination therapy and systemic steroids, until one year of follow-up. No serious systemic or ocular adverse events were noted. Combination therapy appears to be an effective and safe method in the management of recurrent inflammatory CNVM.

Intravitreal ranibizumab in the treatment of fungal endophthalmitis scar-related choroidal neovascular membrane.

The purpose of this study was to report the efficacious use of intravitreal ranibizumab in the management of postfungal endophthalmitis scar-related choroidal neovascular membrane. This is an interventional case report. The patient's visual acuity was stabilized and membrane activity ceased after treatment with three injections of intravitreal ranibizumab at monthly intervals. Intravitreal ranibizumab can be useful in the treatment of inflammatory scar-related choroidal neovascular membrane.

Limited long‐term efficacy of intravitreous anti‐VEGF pharmacotherapy in sarcoidosis complicated by peripapillary choroidal neovascular membrane

Limited long‐term efficacy of intravitreous anti‐VEGF pharmacotherapy in sarcoidosis complicated by peripapillary choroidal neovascular membrane

Inflammatory choroidal neovascular membrane in posterior uveitis-pathogenesis and treatment

Choroidal neovascular membrane (CNVM) formation is a well-documented sight-threatening complication of posterior segment intraocular inflammation (PSII). The aim of this article is to review the basic and clinical science literature on the pathogenesis of CNVM formation in PSII and to present results of a case series. We searched the literature using the mesh terms- inflammation, CNVM, age-related macular degeneration, immunosuppression, photodynamic therapy, steroids, vascular endothelial growth factors and posterior uveitis. Additionally, we evaluated the visual outcome of and clinical response to our standard treatment protocol involving a combination treatment for young patients with inflammatory CNVM. The development of CNVM in PSII is promulgated by infiltrating myeloid cells as well as choroidal and retinal myeloid cell activation, subsequent vascular endothelial growth factors, cytokine and chemokine production and complement activation acting in consort to mediate angiogenic responses. No clear standard of care currently exists for the treatment of inflammatory CNVM and various combinations have been tried. Using our combination treatment, visual acuity improved in four, stabilized in one and worsened in four patients. Though significant advances have occurred in the understanding of the pathogenesis and management of this condition, optimizing therapeutic regimens will require further well-constructed prospective cohort series.

Autofluorescence findings and role of anti-vascular endothelial growth factor in inflammatory choroidal neovascular membrane

Autofluorescence findings and role of anti-vascular endothelial growth factor in inflammatory choroidal neovascular membrane

Inflammatory choroidal neovascular membrane in presumed ocular Lyme borreliosis

Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease. Descriptive review of the clinical records of two patients. Patient 1: 16-year-old healthy male presenting with a visual acuity of counting fingers [oculus dexter (OD)] and 6/6 [oculus sinister (OS)] 3 months after a tick bite. He had papillitis and an exudative subretinal macular lesion OD. Treatment was started with intravenous (IV) ceftriaxone; a week later, IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later, VA had improved to 3/60 OD. Patient 2: 38-year-old healthy female presenting with reduced left-eye vision (6/24) 6 weeks after a tick bite. She also suffered from erythema migrans and arthralgias. She had left-eye papillitis, macular haemorrhages and vascular sheathing. Treatment was started with IV ceftriaxone. One month later, there was profound loss of vision with development of CNVM. Treatment was declined by the patient and eventually retinal fibrosis developed. Inflammatory CNVM has not been described previously in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinically based--both were sero-negative. Visual outcome in the two patients was profoundly impaired because of the ensuing macular scar.