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INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANE: Long-Term Visual and Anatomical Outcomes After Intravitreal Anti–vascular Endothelial Growth Factor Therapy

D'souza, Palmeera, DO, DNB*; Ranjan, Ratnesh, MS*; Babu, Upendra, MS*; Kanakath, Anuradha V., MD; Saravanan, Veerappan R., DNB, FRCS*

doi: 10.1097/IAE.0000000000001710
Original Study

Purpose: To assess the long-term visual and anatomical outcomes after intravitreal anti–vascular endothelial growth factor therapy for inflammatory choroidal neovascular membrane (CNVM).

Methods: Retrospective case series of 15 consecutive cases of newly diagnosed inflammatory CNVM who were treated with intravitreal bevacizumab or ranibizumab injections.

Results: The study included 8 women and 7 men with mean age at presentation with CNVM of 40.53 ± 17.46 years (range, 11–70 years), and mean follow-up duration after anti–vascular endothelial growth factor therapy was 20.53 ± 14.53 months (range, 6–48 months). All eyes had classic CNVM confirmed by fluorescein angiography, most commonly located in the peripapillary area (8 eyes, 53.3%), followed by juxtafoveal (4 eyes, 26.7%), and subfoveal location (3 eyes, 20%). All CNVMs showed complete resolution with mean 2.6 ± 1.2 injections per eye. Preinjection mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.79 ± 0.76 (approximate Snellen equivalent 20/123) and mean central macular thickness of 435.9 ± 190.2 μm improved significantly to mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.46 ± 0.43 (approximate Snellen equivalent 20/58) and mean central macular thickness of 262.13 ± 108.70 μm (P value 0.02 and <0.0001, respectively) at the final visit. Recurrence was seen in 26.7% eyes (4/15), all of which regressed with single injection. Only complication noted was subretinal fibrosis in one eye (6.7%).

Conclusion: For inflammatory CNVM, in addition to immunosuppression in cases with active inflammation, anti–vascular endothelial growth factor therapy seems as a very effective treatment modality resulting in significant visual improvement and foveal flattening. Incidence of major complications is rare, and the recurrence rate seems low.

Intravitreal injection of bevacizumab or ranibizumab for the management of newly diagnosed inflammatory choroidal neovascular membrane resulted in complete anatomical resolution, defined as complete resolution of subretinal or intraretinal fluid, in all eyes with significant visual improvement. The recurrence, defined as reappearance of fluid either subretinal or intraretinal, and complications either by injection or drug related seem to be very low. Recurrent cases carried good prognosis for anatomical regression with treatment.

Departments of *Vitreo-Retina, and

Uvea, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India.

Reprint requests: Ratnesh Ranjan, MS, Department of Vitreo-Retina, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Avinashi Road, Coimbatore 641014, India; e-mail: drratnesh16@gmail.com

Presented in part at 13th Annual Meeting of Uveitis Society of India, Mussourie, India, September 27, 2013.

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.