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C. Gottlieb, L. J. Faia, F. Forooghian, R. B. Nussenblatt, H. N. Sen; Choroidal Neovascularization in the Setting of Uveitis: Clinical Features and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1544.
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To describe the clinical features, treatment modalities and outcomes of uveitic CNV.
Retrospective longitudinal cohort.
Eleven patients (13 eyes) with uveitic CNV followed at the NEI between 1993 and 2008 were identified. There were 8 female and 3 male patients with diagnoses of birdshot chorioretinitis (1), idiopathic posterior uveitis (2), multifocal choroiditis (2), persistent placoid maculopathy (1), PIC (3), serpiginous choroiditis (1) and VKH (1). CNV was unilateral in 8 patients (73%). CNV was the presenting feature of uveitis in only 1 patient (MFC; 9%). The median duration of uveitis until the development of CNV was 12 months (range: 8 months-8 years). The most frequent location of CNV was peripapillary (46%) followed by subfoveal (36%). All patients were treated with a combination of systemic immunosuppressive agents and local therapy for CNV. Uveitis was active in 8 of the 13 occurences of CNV and 56% of the time CNV occurred while patients were off immunosuppressive therapy. CNV occurred at the border of an exisiting chorioretinal scar or active inflammatory chorioretinal lesion in all cases. The average time to resolution of CNV in patients treated with a combination of systemic immunosuppressive therapy and local ocular therapy was 6 months. Although vision improved in some patients with treatment, the difference in pre- and post-treatment visual acuities was not statistically significant (p 0.085).
CNV in the setting of uveitis occurs later in the disease course. Recurrences tend to occur while patients are off systemic immunosuppresive treatment, emphasizing the importance of a combination of systemic immunosuppressive, local ocular therapy and close follow-up. More studies are needed to investigate the role of immunosuppresive therapy in treating inflammatory CNV and preventing recurrence.
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