Choroidal Neovascular Membranes Clinical Presentation.
PPE may be a forme fruste of CSCR, sharing the underlying choroidal pathology but lacking the classic macular subretinal fluid or gravitational tracks of CSCR.3 In some patients with PPE, longstanding RPE changes and possibly RPE detachment can lead to disruption of Bruch’s membrane, leading to ingrowth of sub-RPE choroidal neovascular membranes, resulting in Type 1 CNV.
Peripapillary choroidal neovascular membrane is an exceedingly rare complication of chronic papilledema. Fewer than 15 cases have been reported ( 1-9 ). The presumed pathogenesis is pressure deformity of the border of Bruch's membrane at the level of the optic nerve head creating a discontinuity of the normal anatomic apposition of the chorioretinal layers.
Age-Related Macular Degeneration (AMD) is the most common cause of blindness in the Western world. Currently it is estimated that about 2 million Americans are affected by AMD and by the year 2020 it is projected to be closer to 3 million as life expectancy increases and the aging population expands.(1) This is a critical issue involving a significant proportion of the elderly, as vision is.
Choroidal neovascular membrane (CNVM), often seen in wet macular degeneration, involves the development of new, abnormal, leaking blood vessels in the retina. CNVM is also called: Subretinal neovascular membrane (SRNVM), Choroidal neovascularization (CNV), Wet macular degeneration.
CHOROIDAL NEOVASCULAR MEM- BRANE (CNV)has been described as new, pathological vascular proliferation that originates from the choriocapillaries. There are a number of etiologic condi- tions that may result in CNV see (“Common Causes of CNV,” right.) However, age-related macular degeneration (AMD) is the most common associated etiology.
The key points for choosing the appropriate therapy are (1) the underlying pathology, commonly a choroidal neovascular membrane (CNVM), especially in AMD patients, followed by non-AMD-related CNVM and retinal arterial macroaneurysms (RAM) and (2) the extent and location of the hemorrhage including size, thickness, and location in relation to the fovea and the layer in which the blood is present.
Excision of choroidal neovascular membranes. This involves performing a pars plana vitrectomy then removing the CNV via a retinotomy incision. This method theoretically preserves foveal retinal photoreceptors and is suitable for occult lesions as the precise anatomical boundaries of the CNV do not need to be delineated.