# Diagnostic Challenges in Inflammatory Choroidal Neovascularization

## TL;DR

Inflammatory choroidal neovascularization is a rare but serious eye condition linked to uveitis, and modern imaging techniques like OCT can help with diagnosis.

## Contribution

The paper highlights the diagnostic challenges of iCNV and the potential of OCT and OCT angiography in improving detection.

## Key findings

- Inflammation can cause hypoxia, promoting choroidal neovascularization in uveitis.
- OCT and OCT angiography offer noninvasive tools to distinguish iCNV from choroiditis.
- More research is needed to confirm the role of these imaging techniques in evaluating iCNV activity.

## Abstract

Inflammation plays a key role in the induction of choroidal neovascularization (CNV). Inflammatory choroidal neovascularization (iCNV) is a severe but uncommon complication of both infectious and non-infectious uveitides. It is hypothesized that its pathogenesis is similar to that of wet age-related macular degeneration (AMD), and involves hypoxia as well as the release of vascular endothelial growth factor, stromal cell-derived factor 1-alpha, and other mediators. Inflammatory CNV develops when inflammation or infection directly involves the retinal pigment epithelium (RPE)–Bruch’s membrane complex. Inflammation itself can compromise perfusion, generating a gradient of retinal–choroidal hypoxia that additionally promotes the formation of choroidal neovascularization in the course of uveitis. The development of choroidal neovascularization may be a complication, especially in conditions such as punctate inner choroidopathy, multifocal choroiditis, serpiginous choroiditis, and presumed ocular histoplasmosis syndrome. Although the majority of iCNV cases are well defined and appear as the “classic” type (type 2 lesion) on fluorescein angiography, the diagnosis of iCNV is challenging due to difficulties in differentiating between inflammatory choroiditis lesions and choroidal neovascularization. Modern multimodal imaging, particularly the recently introduced technology of optical coherence tomography (OCT) and OCT angiography (noninvasive and rapid imaging modalities), can reveal additional features that aid the diagnosis of iCNV. However, more studies are needed to establish their role in the diagnosis and evaluation of iCNV activity.