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Choroidal neovascularization

MedGen UID:
154726
Concept ID:
C0600518
Pathologic Function
Synonyms: Choroid Neovascularization; Choroid Neovascularizations; Choroidal Neovascularization; Choroidal Neovascularizations; Neovascularization, Choroid; Neovascularization, Choroidal
 
HPO: HP:0011506
Monarch Initiative: MONDO:0810000

Definition

Choroidal neovascularization (CNV) is the creation of new blood vessels in the choroid layer of the eye. [from HPO]

Conditions with this feature

Primary hyperoxaluria, type I
MedGen UID:
75658
Concept ID:
C0268164
Disease or Syndrome
Primary hyperoxaluria type 1 (PH1) is caused by a deficiency of the liver peroxisomal enzyme alanine:glyoxylate-aminotransferase (AGT), which catalyzes the conversion of glyoxylate to glycine. When AGT activity is absent, glyoxylate is converted to oxalate, which forms insoluble calcium oxalate crystals that accumulate in the kidney and other organs. Individuals with PH1 are at risk for recurrent nephrolithiasis (deposition of calcium oxalate in the renal pelvis / urinary tract), nephrocalcinosis (deposition of calcium oxalate in the renal parenchyma), or end-stage renal disease (ESRD). Age at onset of symptoms ranges from infancy to the sixth decade. Approximately 10% of affected individuals present in infancy or early childhood with nephrocalcinosis, with or without nephrolithiasis, and failure to thrive related to renal failure. The majority of individuals with PH1 present in childhood or early adolescence, usually with symptomatic nephrolithiasis and normal or reduced kidney function. The remainder of affected individuals present in adulthood with recurrent renal stones and a mild-to-moderate reduction in kidney function. The natural history of untreated PH1 is one of progressive decline in renal function as a result of calcium oxalate deposits in kidney tissue and complications of nephrolithiasis (e.g., obstruction and infection) with eventual progression to oxalosis (widespread tissue deposition of calcium oxalate) and death from ESRD and/or complications of oxalosis.
Autosomal recessive inherited pseudoxanthoma elasticum
MedGen UID:
698415
Concept ID:
C1275116
Disease or Syndrome
Pseudoxanthoma elasticum (PXE) is a systemic disorder that affects the elastic tissue of the skin, the eye, and vascular system. Individuals most commonly present with angioid streaks of the retina found on routine eye examination or associated with retinal hemorrhage and/or characteristic papules in the skin. The most frequent cause of morbidity and disability in PXE is reduced vision due to complications of subretinal neovascularizations and macular atrophy. Other manifestations include premature gastrointestinal angina and/or bleeding, intermittent claudication of arm and leg muscles, stroke, renovascular hypertension, and cardiovascular complications (angina/myocardial infarction). Most affected individuals live a normal life span.
Macular degeneration, age-related, 3
MedGen UID:
373276
Concept ID:
C1837187
Disease or Syndrome
Age-related macular degeneration-3 (ARMD3) is characterized by numerous small round yellow lesions visible at the temporal edge of the macula. Larger, less distinct yellow areas near the center of the macula are also observed, which represent areas of pigment epithelial detachment (Stone et al., 2004). For a phenotypic description and a discussion of genetic heterogeneity of age-related macular degeneration, see 603075.
Adult-onset foveomacular vitelliform dystrophy
MedGen UID:
334280
Concept ID:
C1842914
Disease or Syndrome
Adult-onset foveomacular vitelliform dystrophy, also known as adult vitelliform macular dystrophy, adult-type foveomacular dystrophy, adult vitelliform macular degeneration, pseudovitelliform macular degeneration, and adult-onset foveomacular pigment epithelial dystrophy, is characterized by a solitary, oval, slightly elevated yellowish subretinal lesion of the fovea that is similar in appearance to the vitelliform or egg-yolk stage of Best disease (153700). Initially the yellow lesion may be present in only one eye. The size is generally one-third to one disc diameter, and small yellow flecks are seen in the paracentral lesion. Patients usually become symptomatic in the fourth or fifth decade of life with a protracted decrease of visual acuity and mild metamorphopsia. Electrooculographic testing reveals a normal or only slightly reduced Arden ratio, which is intensely abnormal in Best disease. The prognosis is optimistic, as most patients retain reading vision throughout life (Felbor et al., 1997; Yamaguchi et al., 2001). For a discussion of genetic heterogeneity of vitelliform macular dystrophy, see VMD1 (153840).
Late-onset retinal degeneration
MedGen UID:
344198
Concept ID:
C1854065
Disease or Syndrome
Late-onset retinal degeneration (LORD) is an autosomal dominant disorder characterized by onset in the fifth to sixth decade with night blindness and punctate yellow-white deposits in the retinal fundus, progressing to severe central and peripheral degeneration, with choroidal neovascularization and chorioretinal atrophy (Hayward et al., 2003).
Age related macular degeneration 1
MedGen UID:
400475
Concept ID:
C1864205
Disease or Syndrome
Age-related macular degeneration (ARMD) is a progressive degeneration of photoreceptors and underlying retinal pigment epithelium (RPE) cells in the macula region of the retina. It is a highly prevalent disease and a major cause of blindness in the Western world. Drusen, pale excrescences of variable size, and other deposits accumulate below the RPE on the Bruch membrane; clinical and histopathologic investigations have shown that these extracellular deposits are the hallmark of early ARMD. As ARMD advances, areas of geographic atrophy of the RPE can cause visual loss, or choroidal neovascularization can occur to cause wet, or exudative, ARMD with accompanying central visual loss (summary by De et al., 2007). Genetic Heterogeneity of Age-Related Macular Degeneration ARMD2 (153800) is associated with mutation in the ABCR gene (601691) on chromosome 1p, and ARMD3 (608895) is caused by mutation in the FBLN5 gene (604580) on chromosome 14q31. Up to 50% of the attributable risk of age-related macular degeneration (ARMD4; 610698) appears to be explained by a polymorphism in the CFH gene (134370.0008). ARMD5 (613761) and ARMD6 (613757) are associated with mutation in the ERCC6 (609413) and RAX2 (610362) genes, respectively. ARMD7 (610149) and ARMD8 (613778), which both represent susceptibility linked to chromosome 10q26, are associated with single-nucleotide polymorphisms in the HTRA1 (602194) and ARMS2 (611313) genes, respectively. ARMD9 (611378) is associated with single-nucleotide polymorphisms in the C3 gene (120700). ARMD10 (611488) maps to chromosome 9q32 and may be associated with a polymorphism in the TLR4 gene (603030). ARMD11 (611953) is association with variation in the CST3 gene (604312); ARMD12 (613784) with variation in the CX3CR1 gene (601470); and ARMD13 (615439) with variation in the CFI gene (217030). ARMD14 (615489) is associated with variation in or near the C2 (613927) and CFB (138470) genes on chromosome 6p21. ARMD15 (615591) is associated with variation in the C9 gene (120940). There is evidence for a form of ARMD caused by mutation in the mitochondrial gene MTTL1 (590050). A haplotype carrying deletion of the complement factor H-related genes CFHR1 (134371) and CFHR3 (605336) is also associated with reduced risk of ARMD. Lotery and Trump (2007) reviewed the molecular biology of age-related macular degeneration and tabulated the genes associated with ARMD, including those with only positive findings versus genes for which conflicting results have been found.
Age related macular degeneration 13
MedGen UID:
815853
Concept ID:
C3809523
Disease or Syndrome
Age-related macular degeneration (ARMD) is a multifactorial disorder of the central retina that is the most prevalent cause of progressive vision loss in the developed world. As in other chronic age-related diseases, most cases result from interplay between multiple environmental and genetic factors, with a resultant spectrum of phenotypes. In rare cases, ARMD may manifest early, but there is an exponential rise in prevalence after the age of 60 years (summary by Pras et al., 2015). For a phenotypic description and a discussion of genetic heterogeneity of age-related macular degeneration (ARMD), see 603075.
Macular degeneration, early-onset
MedGen UID:
863723
Concept ID:
C4015286
Disease or Syndrome
Patterned macular dystrophy 3
MedGen UID:
934680
Concept ID:
C4310713
Disease or Syndrome
Patterned macular dystrophy-3 (MDPT3), also called Martinique crinkled retinal pigment epitheliopathy, appears in the fourth or fifth decade of life and is characterized by a 'dry desert land' pattern of the fundus, involving the posterior pole initially and progressing from the temporal fovea to the periphery of the retina. Polypoid choroidal vasculopathy, choroidal neovascularization, or atrophic fibrous macular scarring can cause reduced visual acuity after age 50. Late-stage MDPT3 consists of a retinitis pigmentosa (RP; see 268000)-like phenotype due to death of retinal pigment epithelium (RPE) and photoreceptor cells. The dry desert land pattern observed on fundus examination corresponds to an irregular thickness of the Bruch membrane and the RPE, with a scalloped elevation ('crinkling') of the RPE observed on optical coherence tomography (OCT). Full-field electroretinography may be normal at preclinical and early stages of the dystrophy, but later cone and rod responses are severely reduced, consistent with progressive photoreceptor cell dysfunction and death at the final state (summary by Meunier et al., 2016). For a general phenotypic description and discussion of genetic heterogeneity of patterned macular dystrophy, see MDPT1 (169150).
Patterned macular dystrophy 1
MedGen UID:
1646806
Concept ID:
C4551999
Disease or Syndrome
Patterned dystrophies of the retinal pigment epithelium (RPE) refer to a heterogeneous group of macular disorders, characterized by an abnormal accumulation of lipofuscin in the RPE. The lipofuscin is most apparent in the macular area, and its distribution can show various sizes and shapes. High inter- and intrafamilial variability has been described, and retinitis pigmentosa (RP; see 268000)-like changes have sometimes been observed in association with patterned dystrophies (summary by Vaclavik et al., 2012). Three main varieties of patterned dystrophy of the RPE have been described: reticular ('fishnet-like') dystrophy (see 179840 and 267800), macroreticular ('spider-shaped') dystrophy, and butterfly-shaped pigment dystrophy of the fovea. Genetic Heterogeneity of Patterned Macular Dystrophy Also see MDPT2 (608970), caused by mutation in the CTNNA1 gene (116805) on chromosome 5q31; and MDPT3 (617111), caused by mutation in the MAPKAPK3 gene (602130) on chromosome 3p21.
Leukoencephalopathy with mild cerebellar ataxia and white matter edema
MedGen UID:
1638681
Concept ID:
C4554120
Disease or Syndrome
CLCN2-related leukoencephalopathy is characterized by nonspecific neurologic findings, mild visual impairment from chorioretinopathy or optic atrophy, male infertility, and characteristic findings on brain MRI. Neurologic findings include mild ataxia (action tremor and gait instability following initially normal motor development; occasionally, mild spasticity), cognitive impairment in some (typically mild, rarely severe), psychiatric symptoms in some (depression and schizophrenia-like symptoms), headaches in some (usually intermittent, severe, and diffuse) and auditory symptoms in some (hearing loss, tinnitus, vertigo). Affected individuals remain ambulatory, do not require support for walking, and rarely become blind. To date CLCN2-related leukoencephalopathy has been reported or identified in 31 individuals from 30 families. It is not yet known if the findings occurring in a few individuals (i.e., epilepsy and paroxysmal kinesigenic dyskinesia) are part of the phenotypic spectrum or unrelated findings.
Macular dystrophy, retinal, 4
MedGen UID:
1823960
Concept ID:
C5774187
Disease or Syndrome
Retinal macular dystrophy-4 (MCDR4) is characterized by late-onset macular degeneration, with multiple drusen-like deposits, macular geographic atrophy, and choroidal neovascularization. Patients also exhibit extensive retinal dysfunction with impaired rod function (Zhou et al., 2022). For a general phenotypic description and discussion of genetic heterogeneity of retinal macular dystrophy, see MCDR1 (136550).

Professional guidelines

PubMed

Gao H, Chen M, Liu Y, Zhang D, Shen J, Ni N, Tang Z, Ju Y, Dai X, Zhuang A, Wang Z, Chen Q, Fan X, Liu Z, Gu P
Adv Mater 2023 Jan;35(2):e2204994. Epub 2022 Dec 11 doi: 10.1002/adma.202204994. PMID: 36349821
Dhiman R, Rakheja V, Gupta V, Saxena R
Indian J Ophthalmol 2022 Aug;70(8):2800-2815. doi: 10.4103/ijo.IJO_2098_21. PMID: 35918919Free PMC Article
Mahmoudi K, Garvey KL, Bouras A, Cramer G, Stepp H, Jesu Raj JG, Bozec D, Busch TM, Hadjipanayis CG
J Neurooncol 2019 Feb;141(3):595-607. Epub 2019 Jan 18 doi: 10.1007/s11060-019-03103-4. PMID: 30659522Free PMC Article

Recent clinical studies

Etiology

Ranjan R, Salian R, Verghese S, Manayath GJ, D'Souza P, Kanakath AV, Shah PK, Saravanan VR, Venkatapathy N
Eur J Ophthalmol 2022 Jul;32(4):2355-2367. Epub 2021 Oct 7 doi: 10.1177/11206721211048799. PMID: 34615395
Yokoi T, Ohno-Matsui K
Asia Pac J Ophthalmol (Phila) 2018 Nov-Dec;7(6):415-421. Epub 2018 Sep 26 doi: 10.22608/APO.2018290. PMID: 30255668
Leveziel N, Gaucher D, Baillif S, Benouaich X, Chartier C, Grenet T, Gualino V, Krivosic V, Delyfer MN
Eur J Ophthalmol 2016 Nov 4;26(6):511-516. Epub 2016 Aug 1 doi: 10.5301/ejo.5000839. PMID: 27515571
Weber ML, Heier JS
Dev Ophthalmol 2016;55:167-75. Epub 2015 Oct 26 doi: 10.1159/000431194. PMID: 26501802
Thuruthumaly C, Yee DC, Rao PK
Curr Opin Ophthalmol 2014 Nov;25(6):508-12. doi: 10.1097/ICU.0000000000000100. PMID: 25237930

Diagnosis

Yokoi T, Ohno-Matsui K
Asia Pac J Ophthalmol (Phila) 2018 Nov-Dec;7(6):415-421. Epub 2018 Sep 26 doi: 10.22608/APO.2018290. PMID: 30255668
Ohno-Matsui K, Ikuno Y, Lai TYY, Gemmy Cheung CM
Prog Retin Eye Res 2018 Mar;63:92-106. Epub 2017 Oct 28 doi: 10.1016/j.preteyeres.2017.10.005. PMID: 29111299
Spaide RF
Retina 2017 Apr;37(4):609-610. doi: 10.1097/IAE.0000000000001575. PMID: 28207610
Lai TY, Cheung CM
Retina 2016 Sep;36(9):1614-21. doi: 10.1097/IAE.0000000000001227. PMID: 27482641
Thuruthumaly C, Yee DC, Rao PK
Curr Opin Ophthalmol 2014 Nov;25(6):508-12. doi: 10.1097/ICU.0000000000000100. PMID: 25237930

Therapy

Yang S, Li T, Jia H, Gao M, Li Y, Wan X, Huang Z, Li M, Zhai Y, Li X, Yang X, Wang T, Liang J, Gu Q, Luo X, Qian L, Lu S, Liu J, Song Y, Wang F, Sun X, Yu D
Sci Transl Med 2022 Jun;14(647):eabj2177. Epub 2022 Jun 1 doi: 10.1126/scitranslmed.abj2177. PMID: 35648811
Holz FG, Oleksy P, Ricci F, Kaiser PK, Kiefer J, Schmitz-Valckenberg S; COLUMBUS-AMD Study Group
Ophthalmology 2022 Jan;129(1):54-63. Epub 2021 May 3 doi: 10.1016/j.ophtha.2021.04.031. PMID: 33957183
Woo SJ, Veith M, Hamouz J, Ernest J, Zalewski D, Studnicka J, Vajas A, Papp A, Gabor V, Luu J, Matuskova V, Yoon YH, Pregun T, Kim T, Shin D, Bressler NM
JAMA Ophthalmol 2021 Jan 1;139(1):68-76. doi: 10.1001/jamaophthalmol.2020.5053. PMID: 33211076Free PMC Article
Mahmoudi K, Garvey KL, Bouras A, Cramer G, Stepp H, Jesu Raj JG, Bozec D, Busch TM, Hadjipanayis CG
J Neurooncol 2019 Feb;141(3):595-607. Epub 2019 Jan 18 doi: 10.1007/s11060-019-03103-4. PMID: 30659522Free PMC Article
Campochiaro PA
J Mol Med (Berl) 2013 Mar;91(3):311-21. Epub 2013 Jan 18 doi: 10.1007/s00109-013-0993-5. PMID: 23329331Free PMC Article

Prognosis

Rohart C, Le HM, Estrada-Walker J, Giocanti-Auregan A, Cohen SY
Retina 2023 Jun 1;43(6):882-887. doi: 10.1097/IAE.0000000000003746. PMID: 36727798
Jang JW, Kim JM, Kang SW, Kim SJ, Bae K, Kim KT
Retina 2019 Oct;39(10):1995-2003. doi: 10.1097/IAE.0000000000002259. PMID: 30024574
Ikuno Y
Retina 2017 Dec;37(12):2347-2351. doi: 10.1097/IAE.0000000000001489. PMID: 28590964
Tsai ASH, Cheung N, Gan ATL, Jaffe GJ, Sivaprasad S, Wong TY, Cheung CMG
Surv Ophthalmol 2017 Jul-Aug;62(4):462-492. Epub 2017 Feb 9 doi: 10.1016/j.survophthal.2017.01.008. PMID: 28189495
Kaszubski P, Ben Ami T, Saade C, Smith RT
Ophthalmic Res 2016;55(4):185-93. Epub 2016 Feb 13 doi: 10.1159/000443209. PMID: 26871899Free PMC Article

Clinical prediction guides

Obasanmi G, Zeglinski MR, Hardie E, Wilhelm AC, Turner CT, Hiroyasu S, Boivin WA, Tian Y, Zhao H, To E, Cui JZ, Xi J, Yoo HS, Uppal M, Granville DJ, Matsubara JA
Lab Invest 2023 Jun;103(6):100123. Epub 2023 Feb 26 doi: 10.1016/j.labinv.2023.100123. PMID: 36849037
Safi H, Ahmadieh H, Hassanpour K, Safi S
Surv Ophthalmol 2022 Mar-Apr;67(2):579-590. Epub 2021 Jul 29 doi: 10.1016/j.survophthal.2021.07.004. PMID: 34331955
Lin JB, Sene A, Wiley LA, Santeford A, Nudleman E, Nakamura R, Lin JB, Moolani HV, Apte RS
Exp Eye Res 2018 Sep;174:107-112. Epub 2018 Jun 1 doi: 10.1016/j.exer.2018.05.033. PMID: 29864439Free PMC Article
Leveziel N, Gaucher D, Baillif S, Benouaich X, Chartier C, Grenet T, Gualino V, Krivosic V, Delyfer MN
Eur J Ophthalmol 2016 Nov 4;26(6):511-516. Epub 2016 Aug 1 doi: 10.5301/ejo.5000839. PMID: 27515571
Ohno-Matsui K, Kawasaki R, Jonas JB, Cheung CM, Saw SM, Verhoeven VJ, Klaver CC, Moriyama M, Shinohara K, Kawasaki Y, Yamazaki M, Meuer S, Ishibashi T, Yasuda M, Yamashita H, Sugano A, Wang JJ, Mitchell P, Wong TY; META-analysis for Pathologic Myopia (META-PM) Study Group
Am J Ophthalmol 2015 May;159(5):877-83.e7. Epub 2015 Jan 26 doi: 10.1016/j.ajo.2015.01.022. PMID: 25634530

Recent systematic reviews

Zhang XJ, Chen XN, Tang FY, Szeto S, Ling XT, Lin ZX, Tham CC, Pang CP, Chen LJ, Yam JC
Surv Ophthalmol 2023 Nov-Dec;68(6):1011-1026. Epub 2023 Jul 28 doi: 10.1016/j.survophthal.2023.07.006. PMID: 37517683
Jakobsen TS, Fabian-Jessing BK, Hansen S, Bek T, Askou AL, Corydon TJ
Exp Eye Res 2023 Sep;234:109590. Epub 2023 Jul 19 doi: 10.1016/j.exer.2023.109590. PMID: 37474015
Zhang L, Ran QB, Lei CY, Zhang MX
Surv Ophthalmol 2023 Nov-Dec;68(6):1084-1092. Epub 2023 Jun 14 doi: 10.1016/j.survophthal.2023.06.002. PMID: 37321477
Cheong KX, Cheung CMG, Teo KYC
Am J Ophthalmol 2023 Feb;246:192-222. Epub 2022 Sep 24 doi: 10.1016/j.ajo.2022.09.008. PMID: 36162537
Gheorghe A, Mahdi L, Musat O
Rom J Ophthalmol 2015 Apr-Jun;59(2):74-7. PMID: 26978865Free PMC Article

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