It is important to distinguish between treatment of the underlying inflammation (PIC) and the treatment of CNV. 2-pronged approach: Treatment is not always necessary and observation may be appropriate for lesions if they are found in non-sight threatening areas (that is not centrally). Active lesions of PIC can be treated with corticosteroids taken systemically (tablets) or regionally by injections around the eye (periorbital). It has been argued that treating lesions in this way may help minimise the development of CNV. The treatment of CNV: Early treatment is required for this complication. There are several possible treatment methods, but none of these treatments appears to be singly effective for the treatment of CNV. # Corticosteroids: systemic or intraocular # ‘Second line’ immunosuppressants: There is evidence that combined therapies of steroids and second line immunosuppressants may be important. # Surgical excision of the affected area in well selected cases. # Intravitreal anti-VEGF agents. Examples are bevacizumab (avastin) and ranibizumab. These relatively new drugs are injected into the eye. # Photodynamic therapy (PDT): A photosensitive drug is ‘activated’ by strong light. Consideration may be given to combined therapy of PDT and anti VEGF. # Laser photocoagulation: This is occasionally used unless the CNV is subfoveal (affecting the central or macular part of the vision). The laser treatment can damage the vision. The use of the intravitreal anti VEGF agents namely bevacizumab and ranibizumab have been described recently. The current evidence supporting the use of anti-VEGF agents is based on retrospective case studies and could not be described as strong. However, further data from prospective controlled trials are needed before the therapeutic role of anti-VEGF therapy in the uveitis treatment regimen can be fully determined. The anti VEGF agents furthermore have not been shown to have an anti-inflammatory effect. Thus, treatment of the underlying inflammatory disease should play a central role in the management of uveitic CNV. A two-pronged treatment that focuses on achieving control of inflammation through the use of corticosteroids and/or immunosuppressive agents, while treating complications that arise despite adequate disease control with intravitreal anti-VEGF agents, may be useful. Regular monitoring is essential to achieve a good outcome. This is because even if there is no active inflammation, there may still be occult CNV which requires treatment to avoid suffering vision loss.
Punctate inner choroiditis
Arteritic anterior ischemic optic neuropathy
Chronic relapsing inflammatory optic neuropathy
Posterior ischemic optic neuropathy
Toxic and nutritional optic neuropathy
Retinal vasculitis
Autoimmune optic neuropathy
Acute retinal necrosis