© 2019 iConnect Company Pty Ltd All Rights Reserved.   For Questions /  Contact us at masterclasshelp@gmail.com

  • Grey LinkedIn Icon
  • Grey Facebook Icon
  • Grey Google+ Icon
  • Facebook Social Icon
  • Twitter Social Icon
  • Instagram Social Icon

blog

MARCH 24, 2019

CHOROIDAL NEOVASCULAR MEMBRANE (CNVM)

 

 

 

 

 

 

 

 

 

CNVM can be described based on:

  • location relative to the fovea

  • location relative to the RPE

  • relative to FFA findings

LOCATION RELATIVE TO THE FOVEA

  • Subfoveal (underneath fovea)

  • Juxtafoveal (1-199 microns from the fovea)

  • Extrafoveal (200 microns + out from the fovea)

LOCATION RELATIVE TO THE RPE

  • Type 1 CNVM appears beneath the RPE layer and appears as a fibrovascular or haemorrhagic detachment

  • Type 2 CNVM appears above the RPE layer and adjacent SRF leakage

  • Type 3 Retinal Angiomatous Proliferation (RAP)

RELATIVE TO THE FFA FINDINGS

  • Classic appears above the RPE layer and adjacent SRF leakage

  • Occult appears beneath the RPE layer and appears as a fibrovascular or haemorrhagic PED

TYPES OF OCCULT CNVM

  • Retinal angiomatous proliferation (RAP)

  • Polypoidal choroidal vasculapathy (PCV)

Retinal angiomatous proliferation (RAP)

Stage I: intraretinal neovascularisation

Stage II: subretinal neovascularisation

Sage III: vascularised PED

CASE STUDY

A 64 year old female 

 VA RE Hand Movements

Retinal Angiomatous Proliferation (RAP)

(A) Subretinal haemorrhage, serous retinal pigment epithelial (RPE) detachment 

(B,C) FFA and ICGA leakage from choroidal neovascularisation within RPE detachment

(D) Optical coherence topography showing RPE detachment, Dx RAP

Polypoidal Choroidal Vasculapathy (PCV)

  • Predisposing factor: darker pigmention, Asians and African Americans

  • Typically in 7th-8th decade of life

  • Gene HTRA1 and ARMS2 link

  • Commonly misdiagnosed as exudative AMD

  • Abnormal choroidal vasculature with dilation and aneurysmal formation

  • Patients present with subretinal, vascular lessions associated with serous and haemorrhagic PEDs around the peripapillary area

  • ICGA is standard for diagnosis of polypoidal lesion

  • Degeneration of walls of arterioles, capillaries, venules

  • Large vascular channels and "polypoid" formations

  • Thicked capillary basement membranes

  • Hyalinisation of choroidal vessels

  • Exudation of fibrin and plasma

 

TREATMENT

  • Combination Therapy PDT and anti-VEGF therapy

CASE STUDY

A 60 year old woman with reduced visual acuity LE for 2 weeks

BCVA LE 6/48 

Polypoidal Choroidal Vasculapathy 

 

 

 

 

 

 

 

 

 

 

(A) Retinal haemorrhage with exudate at the fovea in colour photograph (see above) 

(B) FFA: polyps (see above)

 

(C) ICGA: branching vascular networks (see above)

(D) OCT section through the polyps reveals local retinal pigment epithelial (RPE) detachments, subretinal and intraretinal fluid, Dx PCV

CLICK HERE TO ASK A QUESTION

Source:

Article Dr Lee Vien.

This is used as a guide only, please consult your local ophthalmologist.