Author: German Allendes Urquiza (Spain)
Co-authors: Beatriz Gonzalo Suárez, Javier Paz Moreno-Arrones, Gabriel Liaño Sanz-Díez de Ulzurrún, Beatriz Son Camey
Purpose
To report the onset of bilateral choroidal peripapillary neovascularization (CNV) following ovarian hormonal stimulation for in vitro fertilization (IVF) in a healthy young woman.
Setting/Venue
Retina subspecialty, Hospital Universitario ‘‘Príncipe de Asturias’’ at Alcalá de Henares, Madrid.
Methods
A 40-year-old women presented with blurred vision and metamorphopsia on her left eye, best-corrected visual acuity was 1.0 in her right eye (OR) and 0.05 on her left eye (OS). As relevant history, she had recently received hormonal stimulation therapy for IVF with gonadotropins, gonadotropin-releasing hormone agonist, estradiol and corticosteroids. Anterior segment and intraocular pressure was normal in both eyes. Dilated fundus examination revealed peripapillary thickening in both eyes, with peripapillary intraretinal hemorrhages while macular thickening on OS. Optical coherence tomography showed thickening of peripapillary retina due to an hyperreflective signal in outter segments in both eyes, with the extension of the lesion to fovea on OS along with intraretinal and subretinal fluid. Meanwhile, OR showed intra-retinal and subretinal fluid in the papillomacular bundle, without fovea affectation. Optical coherence tomography angiography showed positive decorrelation signal in the peripapillary lesions corresponding to subretinal choroidal neovascularization. Fluorescein angiography revealed the presence of peripapillary hyperfluorescent lesions in early frames with fluorescein leakage, suggesting a classic CNV consistent with the tomographic findings
Results
The patient was diagnosed with bilateral papillary choroidal neovascularization and treatment with loading dose of intravitreal Ranibizumab (Lucentis®, Novartis) was initiated with partial response after the first injection.
Conlusions
Choroidal neovascularization (CNV) is a major cause of visual impairment in industrialized countries. Peripapillary subretinal neovascular membranes (PSRNVM) are most commonly associated with age-related macular degeneration and idiopathic causes in older patients. In younger patients, the condition has been linked to a wide variety of other conditions. It has been propose the relationship of CNV development in healthy young patients with hormonal changes such as pregnancy or in vitro fertilization (IVF) treatments. We describe the onset of extrafoveal severe and bilateral CNV in a healthy young woman, following hormonal stimulation for in vitro fertilization. The role of sexual hormones on CNV pathogenesis should be investigated, especially because assisted reproductive techniques are becoming more frequent. Further investigation must be accomplished in order to stablish a possible relationship with these treatments and secondary ophthalmological complications.
Financial Disclosure
No financial support was received for this submission. None of the authors has conflict of interest with this submission
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