INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANES: Clinical Profile, Treatment Effectiveness and Visual Prognosis

Abstract

Purpose To characterise a sample of patients with Inflammatory Choroidal Neovascularization (I-CNV), including clinical profile, underlying aetiology and its course, treatments performed, associated clinical response, and visual prognosis. Methods Retrospective analysis of patients with a diagnosis of I-CNV followed at the Ophthalmology Department of Centro Hospitalar Universitário de São João (CHUSJ). Clinical characterisation and visual outcome classification according to the difference in visual acuity after treatment. Results Twenty eyes from 17 patients were analysed (11 female and 6 male patients, mean age 41.90 ± 16.457 years at CNV diagnosis). Punctate Inner Choroidopathy/Multifocal Choroiditis was the predominant inflammatory aetiology (10 patients, 58.82%). Intravitreal anti-VEGF agents had a median number of 7.00 injections (IQR, 4.25 to 29.00). Median total anti-VEGF injections was superior in eyes belonging to patients with cardiovascular risk factors (35.00 versus 7.00; p = 0.035), eyes belonging to dyslipidemic patients (36.50 versus 6.50; p = 0.010) and eyes that developed cataract (35.00 versus 7.00; p = 0.031), when compared with patients without these conditions. Visual acuity among 20 eyes had a mean gain of 15.10 ± 12.998 ETDRS letters after anti-VEGF treatment. According to our classification, 16 had an improved outcome (80,00%), 3 had a stable outcome (15.00%) and 1 had a worsened visual outcome (5.00%). In addition, 13 eyes (65.00%) had a final VA equal or superior to 65 letters. Conclusion A combined approach with anti-VEGF agents and anti-inflammatory therapy was effective in I-CNV treatment and an overall good visual prognosis was attainable. Intensive follow-up was fundamental in the management of both the primary inflammatory and secondary neovascular conditions. The number of anti-VEGF injections needed to manage neovascularization was significantly associated with the presence of dyslipidaemia, the presence of general cardiovascular risk factors or the development of cataract. Key words Choroidal neovascularization; inflammation; uveitis; vascular endothelial growth factor.