Inflammatory Choroidal Neovascularization Research Articles

Inflammatory gene defects in AMD

AbstractInflammatory markers have been raported in AMD patients at the serum, gene an tissue levels. Of the inflammatory cytokines especially IL‐6, IL‐8 and IL‐10 have been associated with AMD. Inflammatory cytokines are multifunctional molecules potentially stimulating macrophages and other inflammatory cells and choroidal neovascularization (CNV) in AMD lesions. The cytokines a modulate the expression of other inflammatory markers and are associated e.g with elevated levels of CRP in AMD. Targeting these pathways with non‐steroidal anti‐inflammatory agents may be used in future pharmacologic treatments for AMD before and after CNV formation. This presentation reviews current knowledge of inflammatory cytokines in relation to the RPE and AMD in general.

Intravitreal bevacizumab for refractory choroidal neovascularization (CNV) secondary to uveitis

To assess the short-term efficacy and safety of intravitreal bevacizumab injections (IVB) for refractory choroidal neovascularization (CNV) secondary to uveitis. Ten patients affected by choroidal neovascularization secondary to uveitis unresponsive to immunosuppression associated or not with photodynamic therapy (PDT) were consecutively included. All patients underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), fluorescein (FA) and indocyanine green angiographies (ICG), optical coherence tomography (OCT) at baseline, and after IVB injection (1.25 mg/0.05 ml). CNV was subfoveal in eight cases and juxtafoveal in two cases. Mean follow-up was 7.5 months. After treatment, the logMAR BCVA improved from 0.62 +/- 0.4 (Snellen equivalent of 20/55) to 0.45 +/- 0.35 (Snellen equivalent of 20/40) at 1 month (p = 0.01), then remained stable during the follow-up. Mean central macular thickness (CMT) was reduced from 326 +/- 95 microm before treatment to 267 +/- 28 microm (p = 0.03) at last visit. Mean number of IVB was 2.5. Leakage from inflammatory CNV was stopped in three eyes and decreased in seven eyes. No systemic or ocular adverse events were recorded. Intravitreal bevacizumab improves BCVA and reduces central macular thickness in eyes with inflammatory CNV refractory to immunosuppression associated or not with PDT. Further study is necessary to assess the efficacy and safety in the long term.

Pathological findings of multifocal choroiditis with panuveitis and punctate inner choroidopathy

To compare the pathological findings between multifocal choroiditis with panuveitis (MCP) and punctate inner choroidopathy (PIC). Fourteen eyes of 14 patients clinically diagnosed as having MCP or PIC who underwent surgical excision of choroidal neovascularization (CNV) were studied. Immunohistochemical findings of the excised CNV in MCP (eight eyes) and PIC (six eyes) cases were compared. Antibodies against vascular endothelial growth factor (VEGF), CD68, CD3, and CD20 were used as primary antibodies. Expression of VEGF and CD68 in the CNV was observed in all MCF and PIC cases. In three of eight eyes with MCP, intraocular inflammatory findings were found clinically, while immunohistochemical study demonstrated infiltration of CD20-positive B lymphocytes in the CNV. No B lymphocyte infiltration was found in the six eyes with PIC. No differences in pathological findings were found between the five MCP eyes without intraocular inflammation and the six PIC eyes, with all eyes showing no B lymphocyte infiltration. In MPC cases showing clinical inflammatory findings, infiltration of B lymphocytes was also observed histopathologically, suggesting that the presence of inflammatory cells in the anterior chamber or vitreous body clinically is an indicator of active inflammatory CNV. However, this study clarifies that MCP eyes without intraocular inflammation and PIC eyes are not different in histopathological findings.

SDF1-alpha is associated with VEGFR-2 in human choroidal neovascularisation

Endothelial progenitor cells (EPCs) have been shown to contribute to experimentally induced choroidal neovascularisation (CNV) in animal models. The recruitment pathway for EPCs is dependent on the chemokine stromal cell derived factor 1-alpha (SDF) and its receptor CXCR4 on the progenitor cell. We examined 23 specimens of CNV occurring secondary to a variety of aetiologies (10 secondary to age-related macular degeneration (AMD), 4 inflammatory, 4 idiopathic and 5 melanoma-associated) for the presence and distribution of SDF and CXCR4 in order to determine if this pathway may play a role in neovascularisation. Specimens were examined by immunohistochemistry using a panel of antibodies against SDF, CXCR4, vascular endothelial growth factor receptor 2 (VEGFR-2), CD34 (endothelial cells), CD68 (macrophages) and cytokeratins (retinal pigment epithelium; RPE). SDF was detected in 2 cases of CNV in AMD, 1 inflammatory CNV, 3 idiopathic CNVs and in 3 cases of CNV associated with melanoma. A significant association was found between SDF and VEGFR-2 immunostaining in individual membranes ( p < 0.001). Localisation of SDF immunostaining to the presumed RPE was also significant ( p < 0.05). CXCR4 immunostaining was widespread in all membranes in keeping with the published work of other investigators. Our study suggests that SDF, which may be produced by the RPE, could play a role in CNV.

INTRAVITREAL BEVACIZUMAB (AVASTIN) INJECTION AS PRIMARY TREATMENT OF INFLAMMATORY CHOROIDAL NEOVASCULARIZATION

To assess the effects of intravitreal bevacizumab injection as primary treatment of inflammatory choroidal neovascularization (CNV). Data for nine consecutive patients with newly diagnosed inflammatory CNV who were treated with intravitreal bevacizumab (1.25 mg) injection were reviewed retrospectively. Main outcome measures were best-corrected visual acuity, foveal thickness measured by optical coherence tomography (OCT), and complete resolution of CNV. CNV resolved completely in 9 (100%) of 9 affected eyes. At the last examination, visual acuity was improved in 8 eyes (88.8%), stable in 1 (11.2%), and worse in 0. Over a mean follow-up of 7.1 months (range, 6-10 months), 7 eyes received 1 injection, 1 eye developed CNV recurrence and required a second injection, and 1 eye required a third injection. Foveal thickness by OCT decreased significantly (P = 0.049) after treatment. In this small case series of eyes with limited follow-up, intravitreal bevacizumab injection for treatment of inflammatory CNV was found to be safe and was associated with favorable visual outcomes for both subfoveal and juxtafoveal or extrafoveal inflammatory CNV.

Photodynamic therapy in subfoveal and juxtafoveal idiopathic and postinflammatory choroidal neovascularization

To evaluate the efficacy of photodynamic therapy (PDT) in the treatment of idiopathic and inflammatory choroidal neovascularization (CNV). This study represents a non-randomized, multicentre, interventional case series. Sixteen eyes of 16 patients with classic or predominantly classic sub- and juxtafoveal idiopathic CNV and 26 eyes of 24 patients with classic or predominantly classic sub- and juxtafoveal CNV secondary to inflammatory conditions were treated with PDT with verteporfin. Best corrected visual acuity (BCVA) before and after PDT, the number of lines gained or lost and the number of PDT sessions were analysed. The mean follow-up periods were 20 months (SD 11) and 16 months (SD 9) for the idiopathic and inflammatory groups, respectively. The mean BCVA in idiopathic CNV changed from 0.63 logMAR (SD 0.37) before treatment to 0.82 logMAR (SD 0.43) after treatment (p = 0.16; Student's t-test paired data). The number of treatments performed averaged 2.1 (range 1-4, SD 0.9). The mean BCVA in postinflammatory CNV changed from 0.60 logMAR (SD 0.4) before treatment to 0.57 logMAR (SD 0.6) after treatment (p = 0.79; Student's t-test paired data). The mean number of treatments was 2.6 (range 1-6, SD 1.2). Photodynamic therapy with verteporfin may be useful in stabilizing BCVA in patients with sub- and juxtafoveal postinflammatory CNV and subfoveal idiopathic CNV.

Photodynamic therapy of idiopathic and inflammatory choroidal neovascularization in young adults

Purpose To evaluate the treatment of subfoveal choroidal neovascularization (CNV) using photodynamic therapy (PDT) with verteporfin (Visudyne; Novartis, Duluth, GA) in young adults. Design Retrospective noncomparative interventional case series. Participants Nineteen eyes of 17 patients with classic, subfoveal CNV treated with PDT using verteporfin, excluding eyes with CNV secondary to age-related macular degeneration, angioid streaks, and myopia. Main outcome measures Snellen visual acuity before and after PDT. Results Nineteen eyes were followed an average of 12.8 months (range, 4–33 months) after PDT. Before treatment, visual acuity measured ≥20/40 in 0 eyes (0.0%), <20/40 to >20/200 in 11 eyes (57.9%), and ≤20/200 in 8 eyes (42.1%). After treatment, visual acuity measured ≥20/40 in four eyes (21.1%), <20/40 to >20/200 in eight eyes (42.1%), and ≤20/200 in seven eyes (36.8%). Six eyes (31.6%) underwent retreatment, with only two eyes retreated twice. Four eyes underwent eventual surgical removal of the CNV after PDT. Conclusions Photodynamic therapy seems to be useful in stabilizing and improving visual acuity in young adults with subfoveal CNV secondary to idiopathic and inflammatory etiologies.

OCT imaging of choroidal neovascularisation and its role in the determination of patients’ eligibility for surgery

AIMTo evaluate the optical coherence tomographic characteristics of choroidal neovascularisation (CNV) in age related macular degeneration (AMD) and in idiopathic and inflammatory CNV. The use of this technique in the...