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choroidal neovascular membrane; choroidal vascularization (CNVM)
Etiology:
- age-related macular degeneration
- myopia
- ocular histoplasmosis
- sarcoidosis
- multifocal choroiditis
- choroid tumors
- nevi
- ocular melanoma
- hemangioma
- osteoma
- eye trauma
- choroidal rupture
- laser photocoagulation
- idiopathic
Epidemiology:
- 1.2% of patients with macular degeneration
- 5-10% of myopic persons
Pathology:
- growth of new blood vessels that originate from the choroid through a break in the Bruch membrane into the sub retinal pigment epithelium or subretinal space
- may be considered a wound-healing response to injury to the retinal pigment epithelium
- balance between PEDF & VEGF likely determines the growth of the choroidal neovascular membrane
- subretinal blood & fluid
- lipid exudation
- retinal pigment epithelial detachment
- subretinal fibrosis
- fibrocytes & macrophages in > 50% of specimens
Clinical manifestations:
- painless loss of vision
- metamorphopsia
- paracentral or central scotoma
- apparent change in image size
Special laboratory:
- ophthalmoscopy
Radiology:
- fluorescein angiography
- hyperfluorescent in the early phases
- maintains well-demarcated borders
- leaks late (obscuring its borders)
Complications:
- visual loss
Management:
- referral to ophthalmology
- intravitreal anti-VEGF therapy
- pegaptanib (Macugen)
- ranibizumab (Lucentis)
- bevacizumab (Avastin)
- laser photocoagulation
- photodynamic therapy
- verteporfin (Visudyne)
- follow-up
- fluroscein angiography 2 weeks after laser photocoagulation
- prevention: Ocuvite Preservision
Related
choroid
choroidal degeneration
General
choroid disease
References
- Wu L
Medscape: Choroidal Neovascularization
http://emedicine.medscape.com/article/1190818-overview
- Wikipedia: Choroidal neovascularization
http://en.wikipedia.org/wiki/Choroidal_neovascularization