Delayed Choroidal Neovascular Membrane After Unilateral Acute Idiopathic Maculopathy

Area of Science:

• Ophthalmology
• Retinal Diseases
• Vascular Biology

Background:

• Unilateral acute idiopathic maculopathy (UAIM) is an inflammatory condition affecting the macula.
• Delayed complications, such as choroidal neovascular membrane (CNVM), can arise even after apparent recovery from UAIM.

Purpose of the Study:

• To document a case of delayed CNVM development following UAIM.
• To explore the potential role of persistent choriocapillaris dysfunction and inflammation in the pathogenesis of delayed CNVM.
• To evaluate management strategies for this complication.

Main Methods:

• A case report of a 22-year-old woman with a history of UAIM who presented with decreased vision.
• Multimodal imaging including OCT, OCTA, FFA, and ICGA was used to diagnose and characterize a subfoveal CNVM.
• Treatment involved initial intravitreal anti-VEGF therapy (faricimab), followed by the addition of systemic corticosteroids due to persistent activity and inflammation.

Main Results:

• Intravitreal anti-VEGF therapy partially reduced exudation but did not achieve complete disease control.
• Combined anti-VEGF and systemic corticosteroid therapy led to regression of both inflammatory lesions and CNVM activity.
• At final follow-up, exudation resolved, OCTA showed a mature vascular network without active neovascularization, and visual acuity improved from 6/30 to 6/12.

Conclusions:

• CNVM can be a delayed complication of UAIM, potentially linked to persistent choriocapillaris hypoperfusion and inflammation.
• Multimodal imaging is crucial for understanding the mechanisms of delayed CNVM.
• Combined anti-VEGF and anti-inflammatory therapy may be effective for selected patients with delayed CNVM post-UAIM.
• Long-term monitoring is recommended for patients with a history of UAIM.