Subretinal, idiopathic and post-inflammatory neovascularisations

Off-label therapies open up new treatment perspectives for idiopathic and post-inflammatory subretinal neovascularisations (CNVs).

Idiopathic subretinal neovascularisations
In subjects under 50 years of age, the finding of a sub-retinal neovascular membrane (CNV) should promote investigations to rule out associated causes, first pathological myopia, then angioid striae, then posterior segment inflammation (post-inflammatory CNV) (1), or traumatic choroid rupture, iatrogenic (2), optic nerve aplasia (3), choroid osteoma (4), choroidal nevus (5-6), radiation retinopathy (7). Where all these causes have been ruled out, the diagnosis of idiopathic CNV is made. Idiopathic CNVs have a natural history with a benign course, tend to self-limit and regress spontaneously, irrespective of lesion site, with a useful functional residual in most cases (75% ? 20/60), and rare occurrence of recurrence (8-9).
An indication of spontaneous regression and a positive prognostic factor appears to be the presence of a hypofluorescent borderline in ICGA, which is not always visible on ophthalmoscopy and FAG, corresponding to a multi-layered proliferation of the EPR, a sign of an involutional process demonstrated in the animal model and in humans in pseudohistoplasmosis CNVs (10).
Idiopathic CNVs are classified as type 2 according to Gasswith growth above the retinal pigment epithelium: in young subjects the close anatomical adhesion between EPR and Bruch's membrane could explain this growth pattern, and the integrity of the EPR could account for the prognostic evolution better than in other forms of CNV (9, 11).

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Dr. Carmelo Chines
Direttore responsabile

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