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Anastasia Tasiopoulou, Malgorzata Woronkowicz, Susan Lightman, Oren Tomkins-Netzer; Evaluation of the visual outcome for patients treated for Inflammatory Choroidal Neovascularization in a Tertiary Referral Center in United Kingdom. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3158.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the response to treatment and visual outcome for eyes with inflammatory choroidal neovascularization (CNV).
Patients were included if they were diagnosed with a CNV secondary to uveitis. Data was collected regarding best corrected visual acuity (BCVA) and information regarding treatment of inflammatory CNV.
Overall, 204 eyes of 166 patients with non-infectious inflammatory CNV were included. The mean age at CNV diagnosis was 38.98±0.97 years and the mean follow-up was 96.3±5.7 months. The majority of CNV was subfoveal (91 eyes, 44.6%) and the most common aetiologies involved punctate inner choroidopathy (PIC) (145 eyes, 71.1%) and multifocal choroiditis (29 eyes,14.2%). The mean time from diagnosis of uveitis to CNV development was 30.8±4.3 months. Treatment of CNV included mostly oral corticosteroids (158 eyes, 77.4%), anti-VEGF injections (109 eyes, 53.4%), second-line immunosuppression (66 eyes, 32.4%) and local corticosteroid injections (32 eyes, 15.7%). The mean BCVA at baseline was 0.42±0.03 logMAR and reached a significant improvement compared to baseline by 0.07 logMAR (p=0.03) only at 6-month follow-up. Subgroup analysis of eyes treated with anti-VEGF injections as first-line treatment showed statistically significant improvement in BCVA by 0.17 to 0.25 logMAR at different follow-up visits (all p<0.05). Eighty-four eyes (41.2%) experienced a median 1.0 (IQR: 1.0-2.0) CNV recurrences. The mean time to CNV recurrence was 186.4±15.1 months. Risk of incidence of CNV recurrence was reduced by oral corticosteroid therapy (aHR: 0.32, 95% CI: 0.17-0.59) and treatment with anti-VEGF injections (aHR: 0.31, 95% CI: 0.18-0.52). The time to moderate and severe vision loss was 299.4±16.7 and 287.6±13.9 months, respectively. An increase in baseline BCVA by 1 logMAR was associated with 2.88 times higher risk of moderate vision loss (aHR 2.88, 95%CI: 1.22-6.86). Age (aHR: 1.07; 95% CI:1.02-1.12) and baseline BCVA (aHR 4.28, 95% CI:1.52-12.01) were identified as risk factors for incidence of severe vision loss.
Inflammatory CNV is a condition with poor visual outcome and high rate of recurrence, despite the use of different treatment options and especially anti-VEGF injections, which appear to improve this outcome.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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