Inflammatory choroidal neovascularization: An evidence-based update.

Abstract

Inflammatory choroidal neovascularization (iCNV) significantly contributes to vision impairment and ranks as the third primary cause of CNV. Arising from both infectious and noninfectious uveitis, iCNV's pathogenesis involves Bruch membrane rupture, local inflammation, and choriocapillaris ischemia. The diagnosis of iCNV is challenging due to its symptomatic overlap with other uveitis-related conditions. We emphasize the importance of advanced multimodal imaging techniques, particularly optical coherence tomography (OCT) and OCT angiography (OCTA), for early detection and differentiation of iCNV from other types of CNV. Although anti-vascular endothelial growth factor agents have shown high efficacy in treatment, the integration of these treatments with anti-inflammatory therapies remains a critical area of active research. The diversity of uveitis presentations and the rarity of iCNV have resulted in a scarcity of randomized clinical trials, leading to reliance on fragmented data from case reports and series. We consolidate the most recent studies to provide a comprehensive, updated overview of the epidemiology, risk factors, pathogenesis, imaging techniques, and treatment modalities for iCNV, aiming to support clinical decision-making. The absence of standardized guidelines highlights the need for further research to establish best practices for managing iCNV effectively.