Delayed Choroidal Neovascular Membrane After Unilateral Acute Idiopathic Maculopathy

To report a case of delayed choroidal neovascular membrane (CNVM) following unilateral acute idiopathic maculopathy (UAIM) and to highlight the potential role of persistent choriocapillaris dysfunction and inflammation in its pathogenesis and management.

A 22-year-old woman with a previous history of steroid-responsive UAIM presented 9 months later with reduced vision (6/30) in the same eye. Multimodal imaging, including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein angiography (FFA), and indocyanine green angiography (ICGA), was performed to characterize the lesion. A subfoveal CNVM was identified and initially treated with intravitreal faricimab. Owing to persistent vascular activity and the subsequent development of adjacent inflammatory lesions, systemic corticosteroids were added in combination with further anti-VEGF therapy.

Initial anti-VEGF therapy reduced exudation but failed to achieve complete disease control. Following combined anti-VEGF and systemic corticosteroid therapy, both the inflammatory lesions and CNVM activity regressed. At final follow-up, exudation had resolved, OCTA demonstrated a compact mature vascular network without evidence of active neovascularization, and best-corrected visual acuity improved from 6/30 to 6/12.

CNVM may develop as a delayed complication of UAIM despite apparent structural recovery. Persistent choriocapillaris hypoperfusion and recurrent inflammation may contribute to its development, although a causal relationship remains to be established. This case highlights the value of multimodal imaging in identifying the underlying mechanisms of delayed CNVM and suggests that combined anti-VEGF and anti-inflammatory therapy may be beneficial in selected patients. Long-term surveillance is warranted in eyes with UAIM.