eMedicine Specialties > Ophthalmology > Choroid

Neovascularization, Choroidal: Follow-up

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Contributor Information and Disclosures

Updated: Jul 25, 2007

Follow-up

Further Outpatient Care

  • Two weeks following laser photocoagulation, a patient should be observed and have a fluorescein angiogram.

    • Pay special attention to the borders, especially the foveal border, of the laser treatment zone to detect any persistence.
    • If no leakage is detected, the patient should have another fluorescein angiogram 4 weeks later or if there are new changes on the Amsler grid.
    • If no leakage is detected again, another angiogram should possibly be obtained 4-6 weeks later.
  • Clinical examination cannot replace FA during the first 18 months after laser treatment, because most persistent and recurrent leakage occurs during this period.

Complications

  • After 5 years of follow-up study, the MPS reported that 55% of patients with exudative ARMD, 33% of patients with POHS, and 34% of patients with idiopathic CNV had a recurrent or persistent CNV after laser photocoagulation.
    • These recurrences, regardless of etiology, tended to be toward the foveal side and were associated with visual loss.
    • In most cases, photocoagulation of these recurrent CNV is indicated.
    • Laser treatment of peripapillary CNV may be complicated by thermal damage to the papillomacular bundle.
  • Surgical excision of CNV may be complicated by retinal detachment, postvitrectomy cataract, choroidal hemorrhage, epimacular membrane, and macular hole.
    • CNV recurrence following excision occurred in up to 44% of cases.
    • How to effectively manage these recurrences is unclear.

Prognosis

  • Location, growth pattern, type (1 or 2) of CNV, and underlying condition determines the prognosis.
    • The 5-year follow-up of the MPS ARMD study showed that 46% of eyes with extrafoveal CNV that were photocoagulated had severe visual loss (loss of 6 lines or more from baseline) compared to 42% of eyes that were followed. In the juxtafoveal study, 49% of treated eyes compared to 58% of observed eyes had severe visual loss. In the subfoveal study, 22% of treated eyes and 47% of observed eyes had severe visual loss.
    • The 5-year follow-up of the MPS POHS study has shown that 12% of eyes with extrafoveal CNV that were photocoagulated had severe visual loss compared to 42% of eyes that were followed.
      • In the juxtafoveal study, 12% of treated eyes also had severe visual loss compared to 28% of eyes that were followed.
      • The natural history of untreated subfoveal CNV secondary to POHS shows that 14-23% of patients retain 20/40 or better visual acuity.
      • Pilot studies of photocoagulation of subfoveal CNV secondary to POHS were inconclusive.
      • Photocoagulation of peripapillary CNV secondary to POHS reduced severe visual loss from 26% of control eyes to 14% of treated eyes.
    • The 5-year follow-up of the MPS idiopathic CNV study showed that 27% of eyes with extrafoveal CNV that were photocoagulated had severe visual loss compared to 44% of eyes that were followed.
      • Few eyes were entered in the juxtafoveal study; at the 3-year follow-up, 10% of treated eyes versus 27% of observed eyes had severe visual loss.
      • The natural history for idiopathic subfoveal CNV is not necessarily associated with profound loss of vision.
      • Size of CNV seemed to be an important prognostic factor. If the CNV was smaller than 1 disc area at initial examination, prognosis was better.
      • In the MPS, the median visual acuity for untreated extrafoveal and juxtafoveal idiopathic CNV was 20/80.
    • CNV in myopia does not necessarily imply bad prognosis.
      • Up to 50% of patients can expect spontaneous improvement or stabilization of vision.
      • About 25% of extrafoveal CNV becomes subfoveal, but up to 25% of subfoveal CNV involutes spontaneously.

Patient Education

  • Once diagnosed with maculopathy secondary to POHS, the patient is asked to self-monitor each eye with a near card and an Amsler grid.
  • If a disturbance is detected, prompt examination is encouraged.

Miscellaneous

Medicolegal Pitfalls

  • Early detection and treatment may help to reduce the chance of visual loss.
 


More on Neovascularization, Choroidal

Overview: Neovascularization, Choroidal
Differential Diagnoses & Workup: Neovascularization, Choroidal
Treatment & Medication: Neovascularization, Choroidal
Follow-up: Neovascularization, Choroidal
References
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References

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Further Reading

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Keywords

choroidal neovascularization, choroidal NV, CNV, subretinal neovascularization, Bruch's membrane, subretinal space, retinal pigment epithelium, RPE, visual loss, vision loss, vascular endothelium growth factor, VEGF, pigment epithelium derived factor, PEDF

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Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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