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What Is Neovascularization of the Choroid (CNV)?

Neovascularization of the choroid, often called choroidal neovascularization or CNV, is growth of new blood vessels from the choroid through Bruch's membrane toward the retina. These fragile vessels leak fluid and blood under or within the retina. CNV commonly occurs in age related macular degeneration but also appears in high myopia, inflammatory chorioretinal diseases, and other macular disorders. Without treatment, it can lead to scarring of the macula and permanent central vision loss.

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What Is Neovascularization of the Choroid (CNV)?

Neovascularization of the choroid, often called choroidal neovascularization or CNV, is growth of new blood vessels from the choroid through Bruch's membrane toward the retina. These fragile vessels leak fluid and blood under or within the retina. CNV commonly occurs in age related macular degeneration but also appears in high myopia, inflammatory chorioretinal diseases, and other macular disorders. Without treatment, it can lead to scarring of the macula and permanent central vision loss.

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Causes and Mechanisms of CNV

Breaks or defects in Bruch's membrane and retinal pigment epithelium allow choroidal vessels to grow into the subretinal space. Chronic degeneration, inflammation, or mechanical stretching all contribute to this damage. Elevated levels of vascular endothelial growth factor encourage vessel sprouting and maintenance. Conditions such as neovascular age related macular degeneration, pathologic myopia, angioid streaks, and multifocal choroiditis are frequent triggers. Once formed, CNV complexes leak, bleed, and can organize into fibrous scars.

Clinical Features and Presentation

Patients with CNV often notice distortion of straight lines, blurred central vision, or a dark or gray spot in the center of the visual field. Reading and recognizing faces become difficult as the macula is involved. On fundus examination, clinicians may see a gray green subretinal lesion, subretinal or intraretinal hemorrhage, and hard exudates. Fluid under the fovea can create a subtle elevation. Symptoms usually develop in one eye first, but the fellow eye has increased risk over time.

Diagnosis and Imaging Studies

Diagnosis relies strongly on imaging. Optical coherence tomography shows intraretinal and subretinal fluid, pigment epithelial detachments, and the structural outline of the neovascular complex. Fluorescein angiography reveals early hyperfluorescence with late leakage in classic CNV, while indocyanine green angiography can highlight deeper or occult components. OCT angiography allows noninvasive visualization of flow within the neovascular network. These tools guide classification and treatment decisions and help monitor response.

Treatment and Outcome

The mainstay of treatment is intravitreal anti VEGF injections, which reduce leakage and help regress the abnormal vessels. Many patients receive a loading phase of monthly injections followed by individualized maintenance schedules. Photodynamic therapy and focal laser are used far less often but remain options in selected cases. Visual outcomes have improved markedly since anti VEGF drugs became available, though scarring still develops in some eyes. Lifelong monitoring is important because CNV can reactivate or arise in the fellow eye.

FAQs About CNV

Is CNV only caused by age related macular degeneration?

No, it also occurs in high myopia, inflammatory diseases, and other chorioretinal disorders that damage Bruch's membrane and the retinal pigment epithelium.

Will anti VEGF injections cure CNV permanently?

They control activity and can stabilize or improve vision, but CNV can recur, so ongoing follow up and possible retreatment are needed.

Can lifestyle changes prevent CNV?

Healthy habits such as not smoking and controlling vascular risk factors support eye health, but they do not remove existing structural risks like myopic degeneration.

Is CNV always symptomatic?

Early or small lesions can be subtle, which is why regular exams and self testing with tools like an Amsler grid are helpful for those at risk.

References

EyeWiki. ?Choroidal Neovascularization: OCT Angiography Findings.? https://eyewiki.org/Choroidal_Neovascularization%3A_OCT_Angiography_Findings

American Academy of Ophthalmology (AAO). ?What Is Choroidal Neovascularization, How Is It Treated?? https://www.aao.org/eye-health/ask-ophthalmologist-q/choroidal-neovascularization-definition-treatment

American Academy of Ophthalmology (AAO). ?Myopic Choroidal Neovascularization.? https://www.aao.org/eyenet/article/myopic-choroidal-neovascularization

NCBI (PubMed Central). ?Anti-VEGF therapies in the treatment of choroidal neovascularisation.? https://pmc.ncbi.nlm.nih.gov/articles/PMC4420986/

Medscape. ?Choroidal Neovascularization (CNV) ? Overview.? https://emedicine.medscape.com/article/1190818-overview