Peripapillary choroidal neovascularization in pars planitis

A 15-year-old boy with intermediate uveitis - suppressed for the preceding year on immunosuppressive therapy and low-dose corticosteroids - and chronic disc swelling presented with unilateral metamorphopsia, peripapillary subretinal hemorrhage, and subretinal fluid. Fluorescein angiogram confirmed the presence of an active choroidal neovascular membrane. Treatment with intravitreal bevacizumab 1.25 mg every 4 weeks for 4 months resulted in resolution of subretinal fluid, subretinal hemorrhage, and regression of the CNV. The patient's intermediate uveitis remained inactive throughout this time.Review of the existing literature and pathophysiologic consideration suggests that chronic disc edema may be a risk factor for this condition. Peripapillary CNV in the context of intermediate uveitis appears to respond well to VEGF-inhibitor therapy.Choroidal neovascularization (CNV) occurs rarely in the context of intermediate uveitis [1]. Only three such cases have previously been reported in the English literature, two of which presented in a peripapillary location [1,2]. In the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study, representing the experience of five US tertiary uveitis centers including ours, 0/1,978 patients with intermediate uveitis presented with peripapillary CNV (upper limit of a one-sided 97.5% confidence interval = 0.19%). Here, we report a case of peripapillary CNV in a patient with intermediate uveitis and explore the pathophysiology and outcome of this condition. The project was conducted in accordance with the principles of the Declaration of Helsinki, with the approval of the governing Institutional Review Board of the University of Pennsylvania.After completion of the SITE Cohort Study at our center, a 15-year-old male presented to our institution with blurry vision in the inferotemporal quadrant of the left eye for 1 day, which upon further questioning represented metamorphopsia. The patient denied redness, eye pain, light s