Management of Choroidal Neovascular Membranes Associated with Choroidal Nevi

To evaluate the management options for choroidal neovascular membrane (CNVM) associated with choroidal nevus.

Cohort study.

Twenty-four eyes with CNVM associated with choroidal nevus.

Retrospective review of demographic and clinical features and management and outcome of eyes with CNVM associated with choroidal nevus.

Choroidal neovascular membrane status, subfoveal retinal thickness, and visual outcome.

Choroidal neovascular membrane was classic in 20 eyes (83%) and occult in 4 eyes (27%). Of 15 eyes (63%) treated with intravitreal bevacizumab injections, complete regression of CNVM was observed in 6 eyes (40%) and partial regression was achieved in 5 eyes (33%). Visual acuity improved or remained stable in these eyes, and the mean subfoveal retinal thickness decreased significantly from 477 μm to 326 μm. Four eyes (27%) with unresponsive, active CNVM were treated with combined photodynamic therapy (PDT) and bevacizumab therapy; complete or partial regression was observed in 3 eyes with improved or stable visual acuity, and the mean subfoveal retinal thickness decreased from 441 μm to 350 μm. Of 5 eyes (33%) treated with PDT, 4 (80%) showed partial regression. Visual acuity remained stable in these eyes and the mean subfoveal retinal thickness decreased from 370 μm to 334 μm. In 4 eyes with non-vision-threatening CNVM (17%), complete or partial regression was seen in 2 eyes, and CNVM remained active in 2 eyes after observation. Visual acuity remained stable. No significant difference was found between the mean subfoveal retinal thickness at presentation and at the last visit. All choroidal nevi remained stable in thickness and size after a mean follow-up of 30 months.

Intravitreal bevacizumab injection was effective in achieving complete or partial regression of CNVM in 73% of eyes with improved visual acuity and decreased subfoveal retinal thickness. Combined PDT and bevacizumab therapy led to further regression in eyes that had failed treatment with bevacizumab previously. Some cases of choroidal neovascularization associated with choroidal nevi did not seem to threaten the vision.