Peripapillary Choroidal Neovascular Membrane Research Articles

Multiple sclerosis-associated uveitis - A series from South India.

To report clinical profiles of multiple sclerosis (MS)-associated uveitis in seven cases from a single tertiary eye care center in South India. Retrospective case series 2013-2023. Seven cases of MS-associated uveitis were retrieved from our databases. There were five females and two males. The diagnosis of MS was made by the neurologist in all cases. Bilaterality was seen in all cases. Intermediate uveitis was the most common presentation (five cases). It was associated with peripheral retinal vasculitis (two cases) and disc pallor (two cases). Fuchs heterochromic iridocyclitis (one case) and incomplete Vogt-Koyanagi-Harada (VKH)-like presentation with a peripapillary choroidal neovascular membrane (one case) were the other presentations. In the case with incomplete VKH-like presentation, whole genome sequencing revealed a heterozygous non-synonymous variation (c.1228C>T) in exon 10 of TNFRSF1A, suggestive of susceptibility to multiple sclerosis 5 due to mutation in the TNFRS1A gene on chromosome 12p13.31. All cases received systemic steroids. Azathioprine (three cases) and rituximab (three cases) were the commonly used immunomodulatory drugs. The visual outcome was good in all cases at the last follow-up. MS-associated uveitis is underreported in India. This series highlights the clinical profile of MS-associated uveitis in India.

Peripapillary Choroidal Neovascular Membrane Masquerading as Unilateral Optic Disc Swelling.

Peripapillary Choroidal Neovascular Membrane Masquerading as Unilateral Optic Disc Swelling.

Idiopathic intracranial hypertension with peripapillary choroidal neovascular membrane

Idiopathic intracranial hypertension with peripapillary choroidal neovascular membrane

Unilateral Isolated Paucisymptomatic Optic Disc Edema.

Unilateral isolated optic disc edema (UIODE) represents a challenging clinical presentation that frequently precipitates an extensive diagnostic work-up. Patients without an apparent diagnosis despite appropriate investigations are often categorized as having "papillophlebitis," an entity that is poorly defined in the existing literature. Our aim was to describe the characteristics of a series of patients with paucisymptomatic UIODE, determine the optimal diagnostic approach to such cases, and clarify the clinical features of presumed papillophlebitis. We retrospectively identified 29 patients with UIODE who were seen by neuro-ophthalmologists at a single center between 2005 and 2019. Each patient presented with isolated, unilateral disc edema that was either entirely asymptomatic or associated with minimal visual symptoms. Patients underwent a comprehensive neuro-ophthalmic evaluation and several ophthalmic and systemic investigations. Data from the initial visit and all subsequent clinical visits were collected, including patient demographics, examination findings, and details of the diagnostic work-up. Our 29 patients with UIODE were found to have a variety of underlying diagnoses including unilateral papilledema due to idiopathic intracranial hypertension (10 patients), optic nerve sheath meningioma (5), incipient nonarteritic anterior ischemic neuropathy (4), vitreopapillary traction (3), orbital masses (2), a peripapillary choroidal neovascular membrane (1), and presumed papillophlebitis (4). The duration of disc edema varied considerably based on the etiology, but most patients had favorable visual outcomes. A systematic approach to the evaluation of UIODE, combined with long-term follow-up, led to a definite diagnosis in a majority of patients, with only 4 patients presumed to have papillophlebitis, a diagnosis the actual existence of which remains controversial.

Management of Peripapillary Choroidal Neovascular Membrane in Patients With Idiopathic Intracranial Hypertension.

To report the clinical features and treatment outcomes of patients with peripapillary choroidal neovascular membrane (CNVM) secondary to idiopathic intracranial hypertension (IIH). Retrospective, multicenter chart review of patients diagnosed with peripapillary CNVM in the course of the treatment and follow-up of IIH. Records were reviewed from 7 different institutions between 2006 and 2016. Ten patients (13 eyes) with a diagnosis of IIH and at least 3 months of follow-up developed CNVM. Three of the total 10 patients developed bilateral CNVM. The mean time from the diagnosis of IIH to CNVM diagnosis was 41 months. Mean follow-up period was 8 months after diagnosis of CNVM. All patients were treated with acetazolamide for IIH. Seven eyes were observed, and 6 eyes were given anti-vascular endothelial growth factor (anti-VEGF) injections, including bevacizumab, ranibizumab, and aflibercept. All CNVMs regressed with subretinal fibrosis, and visual acuity improved in most patients. Papilledema resolved in only 1 eye, while the other 12 eyes had persistent papilledema at last follow-up. Peripapillary CNVM, a rare complication of IIH, often resolves spontaneously with treatment of IIH. In vision-threatening and/or persistent cases, intravitreal anti-VEGF treatment may be a safe and effective therapeutic option.

One-year outcomes of anti-vascular endothelial growth factor therapy in peripapillary choroidal neovascularisation

PurposeTo report the visual and anatomical outcomes in eyes with peripapillary choroidal neovascularisation (CNV) through 12 months.MethodsThis was a multicentre, retrospective, interventional case series which included treatment-naïve cases of peripapillary...

Prevalence of peripapillary choroidal neovascular membranes (PPCNV) in an elderly UK population-the Bridlington eye assessment project (BEAP): a cross-sectional study (2002-2006).

There is paucity of data on the epidemiology of peripapillary choroidal neovascularisartion (PPCNV). Our aim was to determine prevalence of PPCNV in the elderly UK population of Bridlington residents aged ≥65 years. Eyes with PPCNV in the Bridlington eye assessment project (BEAP) database of 3475 participants were analysed. PPCNV outline was drawn, its area measured, and clock-hour involvement of disc circumference recorded. Location and shortest distance from the lesion edge to fovea were recorded. Masked grading for age-related maculopathy (ARM)/reticular pseudodrusen (RPD) within the ETDRS grid was assigned for each eye using a modified Rotterdam scale. Peripapillary retinal pigment epithelial (RPE) changes/drusen were recorded. Visual acuity (VA) and demographic details analysed separately were merged with grading data. PPCNV were identified in ten subjects, and were bilateral in two (20%), a population prevalence of 0.29%, and 0.06% bilaterality. Gender-specific prevalence were 0.36% and 0.19% for females and males, respectively. Age ranged from 66 to 85 years [mean 76.3 (SD 6.4)]. PPCNV were located nasal to disc in 41.7%, measuring 0.46-7.93 mm2 [mean 2.81 mm2 (SD 2.82)]. All PPCNV eyes had peripapillary RPE changes. One subject had no ARM, 1 angioid streaks, and 30% RPD. No direct foveal involvement, or reduced VA attributable to PPCNV was observed. PPCNV were infrequent in this population, more common in females, and often located nasal to the disc, without foveal extension. Peripapillary degenerative changes were universal, and strong association with ARM was observed in eyes with PPCNV. Typically, PPCNV were asymptomatic with VA preservation.

Successful management of peripapillary choroidal neovascular membrane secondary to idiopathic intracranial hypertension with intravitreal ranibizumab

Idiopathic intracranial hypertension (IIH) is a common cause of papilledema in young females and causes headache with transient visual loss. Severe visual loss occurs due to optic atrophy or peripapillary choroidal neovascular membrane (PCNVM). PCNVM in IIH has an incidence of 0.5% with a benign course in the majority of patients. Intravitreal Anti-vascular endothelial growth factor agents have anecdotally been used to manage these patients, with complete resolution reported in all cases after a single injection. Our case of IIH-associated PCNVM was treated with three injections of intravitreal ranibizumab with no recurrence at 6-month follow-up.

The incidence of neovascular membranes and visual field defects from optic nerve head drusen in children

To evaluate the incidence of visual field defects and choroidal neovascular membranes (CNVM) in a cohort of pediatric patients with optic nerve head drusen (ONHD). The medical records of children with ONHD seen at a single center from January 2012 to July 2014 were retrospectively reviewed to identify patients who had a dilated fundus examination, fundus photography, spectral domain optical coherence tomography (SD-OCT)/enhanced-depth imaging (EDI) of the optic nerve head (ONH), SITA fast 24-2 Humphrey visual field (HVF) testing, lumbar puncture, and ocular ultrasound. A masked neuro-ophthalmologist analyzed fundus photographs, OCT, and fields. Retinal nerve fiber layer (RNFL) data were compared to age-matched controls. A total of 52 children (98 eyes) were included. Mean age was 10.8±3.3years. Of these, 42 patients had visual fields (57 eyes deemed reliable), and 19 eyes had documented visual field deficits (8 were reproducible across ≥1 sitting [frequency 14%]). After correction of plotting errors (40 eyes), RNFL thickness was 111.9±17.9μm. CNVM were present in 24 of 98 eyes (24.5%), with 21 of 24 located nasally (87.5%). Neither RNFL thinning nor identification of ONHD on fundus photography correlated with the presence of visual field defects. Visual field defects due to ONHD can be reliably identified in children. In eyes of children with ONHD, RNFL protocol is frequently unreliable and may overestimate RNFL thickness. EDI scans through the ONH revealed peripapillary CNVM in nearly a quarter of the patients. Further longitudinal studies looking at the progression of CNVM and visual field deficits are warranted.

RECURRENT SUBRETINAL HEMORRHAGE ASSOCIATED WITH RIVAROXABAN ANTICOAGULATION.

To report a case of spontaneous recurrent significant subretinal hemorrhage in a patient on rivaroxaban (Xarelto). A case report of a 63-year-old man on rivaroxaban with peripapillary choroidal neovascular membrane and macula involving subretinal hemorrhage. Improvement in visual acuity from 20/200 to 20/30 and restoration of foveal contour after pneumatic displacement of hemorrhage with C3F8 gas and subsequent treatment with ranibizumab. The authors report a case of recurrent subretinal hemorrhage associated with rivaroxaban use. Pneumatic displacement and subsequent treatment of choroidal neovascular membrane with intravitreal ranibizumab improved visual acuity.

Toxocara polymerase chain reaction on ocular fluids in bilateral granulomatous chorioretinitis

To report a rare case of bilateral granulomatous chorioretinitis complicated by bilateral peripapillary choroidal neovascular membranes. This is the first reported case in Australia where intravitreal injections of anti-vascular endothelial growth factor ranibizumab were used to successfully treat choroidal neovascular membrane caused by granulomatous chorioretinitis. This is also the first reported case in Australia of Toxocara polymerase chain reaction being performed on intraocular fluids.

Regression of peripapillary choroidal neovascular membrane in a patient with sarcoidosis after oral steroid therapy

Choroidal neovascular membrane (CNV) may occur in patients with posterior uveitis. Treatment of patients with corticosteroids induces regression of the inflammation in the posterior pole with downregulation of many cytokines including vascular endothelial growth factors. We report herewith, a case of biopsy proven sarcoidosis that developed posterior uveitis and peripapillary CNV membrane and subretinal hemorrhage with fluid. The patient was treated with systemic steroids. She demonstrated progressive regression of the CNV membrane and complete resolution of the subretinal hemorrhage and fluids. In conclusion, control of the posterior segment inflammation is crucial in the resolution of the CNV membrane in uveitis and the intravitreal anti-vascular endothelial growth factor may not be always indicated.

Intravitreal Bevacizumab in the Treatment of Peripapillary Choroidal Neovascular Membrane Secondary to Idiopathic Intracranial Hypertension

A 14 year-old Caucasian boy with idiopathic intracranial hypertension (IIH) presented with blurred vision in his left eye. Visual acuity was 20/20, right eye, and 20/80, left eye, and funduscopy revealed bilateral papilledema. In addition, there was peripapillary choroidal neovascular membrane (PPCNVM) in the left eye. Oral acetazolamide improved the symptoms and signs of IIH, but seven weeks later, acuity remained 20/80, left eye, with an increase in subretinal hemorrhage. Two weeks following an intravitreal injection of bevacizumab, visual acuity on the left had improved to 20/30 with resolution of subretinal hemorrhage and fibrosis of PPCNVM. After an additional 2 weeks, visual acuity improved to 20/20, and there has been no sign of recurrence over 3.5 years of follow-up.

Peripapillary Choroidal Neovascular Membrane in a Teenage Boy

Peripapillary choroidal neovascular membrane (ppCNVM) is an infrequent finding in patients with idiopathic intracranial hypertension (IIH). In the pediatric subgroup there is only a single previously reported case. We describe the use of intravitreal bevacizumab for ppCNVM in a teenage boy with IIH.

Treating peripapillary choroidal neovascular membranes: a review of the evidence

Peripapillary choroidal neovascular membranes (PCNM) are defined as a collection of new choroidal blood vessels, any portion of which lies within one disc diameter of the nerve head. There are two types of PCNM, and correct pre-interventional identification of growth site has been shown to stratify the chance of visual improvement following therapy. Clinical manifestations occur only where the membrane extends over the macula, if the vessels haemorrhage into the subretinal space or fluid exudation occurs within the macula. This review provides an update and overview on the diverse range of current treatment studies and strategies being used in present clinical ophthalmic practice.

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

CHOROIDAL NEOVASCULAR MEMBRANE IN PERSISTENT FETAL VASCULATURE SYNDROME MANAGED WITH INTRAVITREAL PEGAPTANIB SODIUM IN AN INFANT

The purpose of this study was to report the successful management of a case of choroidal neovascular membrane secondary to persistent fetal vasculature syndrome in an infant using intravitreal pegaptanib sodium (Macugen). A 14-month-old male infant developed a peripapillary choroidal neovascular membrane 10 months after lens-sparing vitrectomy that he underwent for persistent fetal vasculature syndrome and confirmed on angiography and optical coherence tomography. A single dose of intravitreal pegaptanib sodium (0.3 mg) was administered after informed consent was obtained. Angiography and optical coherence tomography scans were performed at 6 and 14 weeks after the injection to determine the result. Six weeks after the single injection, the lesion reduced in size and exhibited less leakage on angiography. At 14 weeks, leakage was absent, and the lesion had involuted. Choroidal neovascular membrane in a case of persistent fetal vasculature syndrome is rare. This report shows that intravitreal pegaptanib sodium is highly effective in treating this lesion even in an infant.

Breakthrough vitreous hemorrhage after ICGA guided PDT for PCV

Dear Editor, Polypoidal choroidal vasculopathy (PCV) is a type of choroidal neovascularization, associated with recurrent serosanguineous detachments of the retinal pigment epithelium and the neurosensory retina, secondary to leakage and bleeding from the choroidal vascular lesions.[1] Indocyanine green angiogram (ICGA)-guided photodynamic therapy (PDT) with verteporfin in the treatment of associated choroidal neovascular membrane (CNVM) has shown encouraging results, with the postulation being that ICGA-guided targeting reduces collateral damage to the choriocapillaris, thus reducing the up-regulation of vascular endothelial growth factor.[2] We report a case of breakthrough vitreous hemorrhage after ICGA-guided PDT for PCV. A 69-year-old Indian lady presented with sudden diminution of vision in the left eye since one week. Visual acuity was 20/20, N6 in the right eye and 20/30, N6 in the left eye. Anterior segment examination was essentially normal except for early cataractous changes in both eyes. Right fundus was normal. Left fundus revealed sub-macular hemorrhage. Fundus fluorescein angiography (FFA) [Fig. 1A] and ICGA suggested PCV with multiple subretinal polypoidal lesions and a peripapillary CNVM in the left eye. The patient underwent ICGA-guided PDT in that eye with two non-confluent spots of 3 mm each [Fig. 1B]. Three weeks later, vision dropped to bare perception of light. Fundus examination revealed vitreous hemorrhage with no retinal view. Ultrasound showed multiple vitreous echoes with attached retina.Figure 1A: Fundus fluorescein angiography (FFA) reveals multiple, hyperfluorescent, pinpoint subretinal lesions around the optic disc suggestive of polypoidal choroidal vasculopathy in the left eye. Blocked fluorescence is secondary to subretinal hemorrhageFigure 1B: Indocyanine Green Angiography (ICGA) reveals numerous other polypoidal lesions with a peripapillary choroidal neovascular membrane (CNVM) inferior to the optic disc typical of polypoidal choroidal vasculopathy. Circles indicate photodynamic therapy (PDT) treatment spotsThe patient underwent pars plana vitrectomy for ‘breakthrough vitreous hemorrhage’ and the suspected site of breakthrough vitreous bleed was lasered. Fourteen per cent perfluropropane served as endotamponade. Six weeks later, fundus evaluation revealed altered sub-retinal hemorrhage inferior to the macula [Fig. 2A]. FFA showed peripapillary staining and macular window defects with no leakage [Fig. 2B]. One month later, fundus remained stable. Best corrected visual acuity improved to 20/40, N6.Figure 2A: Color fundus montage of left eye at 13 weeks follow-up revealed altered subretinal hemorrhage, regressed peripapillary choroidal neovascular membrane (CNVM) and absorbing subretinal hemorrhage along the inferior vascular arcades. The yellow circle in the infero-nasal quadrant indicates the area of endolaser photocoagulationFigure 2B: Fundus fluorescein angiography (FFA) at 13 weeks followup reveals staining of peripapillary choroidal neovascular membrane (CNVM) with no leakage. Multiple peripapillary and macular window defects are also seenRecent case series analyzing the hemorrhagic complications of PDT for PCV have reported a 6.59% incidence of breakthrough vitreous hemorrhage subsequent to sub-retinal hemorrhage following treatment.[34] In our institute, 41 eyes of 26 patients underwent PDT for PCV between June 2001 and August 2007. However, breakthrough vitreous hemorrhage was noted only in a single eye. Hence, the incidence of vitreous hemorrhage after PDT for PCV in our practice amounts to 2%. This is much lower than that reported in the Japanese population (6.59%).[3] The earliest development of vitreous hemorrhage was noted at 29 days post-PDT. Significant visual decline was noted in 50% of cases, including that of massive suprachoroidal hemorrhage and profound visual loss.[34] Our case had the earliest reported presentation (21 days) following PDT. Although the patient had diabetes mellitus there was no evidence of proliferative retinopathy which could account for the vitreous hemorrhage. The PDT spot size in the reported case was 3.0 mm [Fig. 1B]. The mean PDT spot size in the other 40 eyes was 3.55 mm. Hence, we did not find a positive correlation between the PDT spot size and the tendency for breakthrough vitreous hemorrhage following PDT. To the best of our knowledge, this is the first case report of breakthrough vitreous hemorrhage, after PDT for PCV, from the Indian subcontinent. The patient achieved satisfactory clinical and visual stability after surgery, at four months.

Treatment of peripapillary choroidal neovascular membranes with intravitreal bevacizumab

Aims:To evaluate the effect of intravitreal injections of bevacizumab in the treatment of peripapillary choroidal neovascular membranes.Methods:Interventional case series of patients with active peripapillary choroidal neovascular membranes. Ophthalmological examination included...

Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India

To report 'posterior sympathetic ophthalmia' in North Indian population as an early manifestation of sympathetic ophthalmia. Forty consecutive patients with a diagnosis of sympathetic ophthalmia seen between 1989 and 2004 at our centre were studied for their clinical presentation and disease course. All received systemic corticosteroids and 12 patients, in addition, also received immunosuppressive agents. There were 28 male and 12 female patients with a median age of 29.4 years. In 22 of the 40 sympathizing eyes, the only presenting sign was the fundus lesions without any associated anterior segment inflammation. Only four eyes showed classically described granulomatous anterior uveitis at presentation. The fundus lesions predominately included exudative retinal detachment (29 eyes), yellowish-white mid-peripheral lesions (10 eyes), optic disc oedema (15 eyes), vasculitis (three eyes), and peripapillary choroidal neovascular membrane (two eyes). Over a median follow-up of 5.2 years, recurrences were seen in 12 of 40 (30%) eyes and were mainly in the anterior segment. Over a median follow-up of 5.2 years, a final visual acuity of 20/40 or better could be achieved in 29/36 (80.5%) eyes. In the early stage, sympathetic ophthalmia may present only in the posterior segment without any associated anterior segment inflammation and carries a good visual prognosis. Anterior segment inflammation, however, maybe seen during recurrences.