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Choroidal neovascularisation CNV

Choroidal neovascularisation CNV. PDT,TTT,MPC ALI . SALEHI MD. CNV is an important cause of visual Impairment and may develop from more than 30 ocular diseases. The most common causes of CNV are ARMD Pathologic myopia. ARMD. Non neovascular (Nonexudative) Neovascular (exudative)

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Choroidal neovascularisation CNV

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  1. Choroidal neovascularisationCNV PDT,TTT,MPC ALI . SALEHI MD

  2. CNV is an important cause of visual Impairment and may develop from more than 30 ocular diseases. The most common causes of CNV are • ARMD • Pathologic myopia

  3. ARMD Non neovascular (Nonexudative) Neovascular (exudative) The hallmark of nonexudative form is drusen. The hallmark of neovascular is the presence of CNV.

  4. Prevalence Is the most common cause of irreversible visual loss in the world in individuals over 50 years of age (1.7%) Age % of patients 65-75 10% >75 30%

  5. AMD is a major cause of visual impairment in the USA. • 1.8 million Americans age 40 and older have advanced AMD and another 7.3 million people with intermediate AMD are at substantial risk for vision loss. • By 2020 there will be 2.9m people with advanced AMD.

  6. Nonneovascular changes with AMD can increase a break in bruch’s membrane . • neovascular tissue from choriocapillaris to perforate the outer aspect of BM. • These new vessels are accompanied by fibroblasts • Fibrovascular complex Proliferates withinthe inner aspect of BM. • CNV in the fovea is the major cause of severe central visual loss , in AMD

  7. FA pattern of CNV • Classic CNV • Occult CNV • Classic CNV is an area of bright fairly uniform hyperflorscence identified in the early phase of the FA

  8. That progressively intensifies and with leakage of dye obscuring the boundaries of this area by the late phases. Occult CNV : (2Forms) • Fibrovascular PED • Late leakage of an undetermined source

  9. 3 terms are important: • Predominantly classic CNV • Minimally classic CNV • Occult CNV with no classic

  10. Predominantly classic • Lesions where the CNV occupies more than 50% of the lesion , including contiguous blood , pigment, scar, and staining. Minimally classic • When the proportion of classic CNV occupies between 1-49% of the entire lesion. Occult with no classic CNV • there is no classic CNV in the lesion( only occult CNV)

  11. Management of the neovascular form of AMD • Laser photocoagulation (thermal laser) • Photodynamic therapy (PDT) • T.T.T (Transpupillary Thermo Therapy) • Antiangiogenic drugs (Avastin,Lucentice)

  12. The benefits of laser (MPC) therapy have been shown only for classic CNV and the benefits of PDT only for lesions that are predominantly classic or purely occult CNV.

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