Servillo Andrea, Scandale Pierluigi, Oldoni Gloria, Begar Pinar Guran, Bandello Francesco, Miserocchi Elisabetta, Cicinelli Maria Vittoria
Ophthalmology Unit, IRCSS Ospedale San Raffaele, Via Olgettina 60, Milan 20132, Italy; School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, Milan 20132, Italy.
Department of Ophthalmology, Ankara University School of Medicine, Ankara 06620, Turkey.
Surv Ophthalmol. 2025 May-Jun;70(3):451-466. doi: 10.1016/j.survophthal.2024.12.004. Epub 2024 Dec 18.
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.
炎症性脉络膜新生血管(iCNV)是导致视力损害的重要原因,也是脉络膜新生血管的第三大主要病因。iCNV由感染性和非感染性葡萄膜炎引起,其发病机制涉及 Bruch 膜破裂、局部炎症和脉络膜毛细血管缺血。由于iCNV与其他葡萄膜炎相关疾病存在症状重叠,其诊断具有挑战性。我们强调先进的多模态成像技术,特别是光学相干断层扫描(OCT)和 OCT 血管造影(OCTA)在早期检测 iCNV 并将其与其他类型的脉络膜新生血管区分开来方面的重要性。尽管抗血管内皮生长因子药物在治疗中显示出高效性,但将这些治疗与抗炎疗法相结合仍是一个关键的积极研究领域。葡萄膜炎表现的多样性和 iCNV 的罕见性导致随机临床试验稀缺,从而依赖于病例报告和系列研究中的零散数据。我们整合了最新研究,以全面、更新地概述 iCNV 的流行病学、危险因素、发病机制、成像技术和治疗方式,旨在支持临床决策。缺乏标准化指南凸显了进一步研究以建立有效管理 iCNV 的最佳实践的必要性。