Type 1 inflammatory choroidal neovascular membrane in a case of viral uveitis - a case report

TL;DR

A rare case of type 1 choroidal neovascular membrane caused by viral uveitis was successfully treated with anti-VEGF therapy and corticosteroids.

Contribution

This is the first reported case of type 1 CNVM arising from viral conjunctivitis progressing to posterior uveitis.

Findings

Inflammatory type 1 CNVM is a rare complication of viral uveitis, occurring in approximately 2% of cases.

Combination therapy with anti-VEGF agents and oral corticosteroids led to complete resolution of CNVM with no recurrence.

Early detection and treatment are crucial for favorable visual outcomes in such cases.

Abstract

Inflammatory type 1 CNVM is a severe but uncommon complication associated with posterior uveitis.

We report a case of type 1 CNVM in a 50-year-old man with a documented history of viral ocular infection. Although inflammatory CNVM is frequently associated with posterior uveitis due to tuberculosis and toxoplasmosis, its occurrence secondary to viral uveitis is rare. The patient's medical history included fever followed by viral conjunctivitis accompanied by superficial punctate keratopathy, for which he was undergoing treatment elsewhere. Despite treatment, he continued to experience pain, redness, photophobia, and metamorphopsia. Upon presentation at our centre,one month following the initial symptoms, a diagnosis of posterior uveitis and CNVM was established, which had not been detected during prior ophthalmological examinations. The subsequent administration of intravitreal anti-VEGF agents along with oral corticosteroids resulted in a dramatic resolution of CNVM.

To the best of our knowledge, similar case that started with viral conjunctivitis, anterior uveitis and later progressed to posterior uveitis with a type 1 CNVM has not been reported till date. Inflammatory cells released during uveitis can lead to breakage of Bruch's-RPE complex and lead to CNVM. There is no proper consensus in treating inflammatory CNVM.A combination of intravitreal anti-VEGF agents and intravitreal steroids or oral steroids have been tried by various studies.

Unilateral CNVM developed within one month following an episode of posterior uveitis that initially presented as viral conjunctivitis. Early recognition and timely management with intravitreal anti-VEGF therapy combined with systemic corticosteroids resulted in a favorable visual outcome, with no recurrences observed during the follow-up period.

•Inflammatory CNVM is a rare complication[∼2%] associated with viral uveitis.•We report a case that presented with viral conjunctivitis, later progressed to posterior uveitis and type-1 CNVM•Even mild viral conjunctivitis need close follow-up if vision complaints occur, requiring complete examination and prompt diagnostic tests.•CNVM was successfully treated with anti-VEGF agents combined with oral corticosteroids, with no recurrences.

Inflammatory CNVM is a rare complication[∼2%] associated with viral uveitis.

We report a case that presented with viral conjunctivitis, later progressed to posterior uveitis and type-1 CNVM

Even mild viral conjunctivitis need close follow-up if vision complaints occur, requiring complete examination and prompt diagnostic tests.

CNVM was successfully treated with anti-VEGF agents combined with oral corticosteroids, with no recurrences.

Figures