Ocular Conditions Associated with Peripapillary Subretinal Neovascularization, Their Relative Frequencies, and Associated Outcomes

Objective: To determine frequency and outcomes of conditions with peripapillary subretinal neovascular membranes (PSRNVMs).

Design: Retrospective observational case series.

Participants: All patients from a private community-based retina practice diagnosed with a PSRNVM.

Methods: Review of clinical charts, photographs, and fluorescein angiograms of 115 eyes of 96 patients, accrued over 18 years.

Main Outcome Measures: Demographics, visual acuity (VA), laterality, neovascular membrane type and recurrence status over treatment course, and associated ocular conditions.

Results: Prevalences of reported associations were 52 (45.2%), age-related maculopathy (ARM); 45 (39.1%), idiopathic; 5 (4.3%), multifocal choroiditis; 3 (2.6%), angioid streaks; 2 (1.7%), histoplasmosis; 2 (1.7%), choroidal osteoma; 1 (0.9%), optic disc drusen; and 1 (0.9%), congenital disc anomaly. Newly recognized associations include pattern dystrophy (3 [2.6%]) and peripapillary pseudopodal pigment epithelial and choroidal atrophy (1 [0.9%]). Second-eye involvement was observed in 19.8% of patients over a median follow-up of 2 years. Median initial VAs were 20/40 for ARM-associated eyes and 20/30 for idiopathic eyes (P = 0.0230). Median final VAs were 20/70 for ARM-associated eyes and 20/32 for idiopathic eyes (P = 0.0261). The VA changes in the ARM-associated and idiopathic groups did not differ significantly (P = 0.1453). Recurrence of PSRNVMs after laser ablation was seen in 14 of 73 eyes (19.2%). A case of a PSRNVM as a cause of pseudopapilledema leading to unnecessary neurological imaging is reported.

Conclusions: Close inspection of fellow eyes at the time of first eye diagnosis and regular follow-up afterward are indicated, given the high rate of eventual bilateral involvement regardless of associated condition. Laser ablation of PSRNVMs with broad treatment margins reduces recurrence rates relative to earlier series. The differential diagnosis of disc edema should include PSRNVMs. Pattern dystrophy can be associated with PSRNVMs.