Introduction:

Subretinal neovascularization is a complex ocular condition characterized by the abnormal proliferation of blood vessels beneath the retina, specifically under the retinal pigment epithelium (RPE). This phenomenon is a key feature of several retinal diseases and can lead to significant vision impairment or even blindness if left untreated. This article offers an exhaustive exploration of subretinal neovascularization, elucidating its origins, clinical manifestations, diagnostic pathways, and therapeutic measures.

Causes of Subretinal Neovascularization:

• Age-related Macular Degeneration (AMD): The "wet" form of AMD is a predominant cause, where new blood vessels grow beneath the retina and leak fluid.
• Pathologic Myopia: Extreme nearsightedness can lead to retinal thinning and subsequent abnormal blood vessel growth.
• Ocular Histoplasmosis Syndrome: A condition stemming from a fungal infection that affects the retina.
• Retinal Angiomatous Proliferation (RAP): A subtype of AMD where blood vessels grow both under and within the retina layers.
• Choroidal Rupture: Traumatic injuries can cause breaks in the choroid, prompting neovascularization.
• Inflammatory Diseases: Conditions like posterior uveitis can induce neovascularization.

Symptoms of Subretinal Neovascularization:

• Visual Distortion: Straight lines may appear wavy or misshapen.
• Blurred or Diminished Vision: This can be a gradual or sudden onset.
• Central Scotoma: A noticeable blind or dark spot in the central vision.
• Metamorphopsia: A distortion where objects might appear skewed in size or distance.
• Visual Field Defects: Loss or impairment of peripheral vision.
• Color Perception Changes: Colors may appear faded or altered.

Diagnosis of Subretinal Neovascularization:

• Clinical Examination: A comprehensive eye exam using ophthalmoscopy to inspect the retina's layers.
• Fluorescein Angiography: After injecting a dye, photos of the retina are captured to trace the dye's flow and highlight abnormal vessels.
• Optical Coherence Tomography (OCT): This imaging technique offers high-resolution, cross-sectional images of the retina, revealing the location and extent of neovascularization.
• Indocyanine Green Angiography: This technique visualizes deeper choroidal blood vessels, providing a more comprehensive view than fluorescein angiography.
• B-scan Ultrasonography: Useful when media opacity prevents a clear view of the retina.

Treatment of Subretinal Neovascularization:

• Anti-VEGF Therapy: Medications like ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin) are injected into the eye to inhibit the vascular endothelial growth factor (VEGF), a protein promoting vessel growth.
• Photodynamic Therapy (PDT): A light-sensitive drug is activated in the retina using a laser, selectively damaging abnormal blood vessels without harming surrounding tissue.
• Laser Photocoagulation: A direct laser treatment that seals off leaking blood vessels, preventing further fluid accumulation.
• Corticosteroids: These can be injected or implanted into the eye to reduce inflammation and vessel growth.
• Surgery: In advanced cases, surgical interventions like vitrectomy might be considered.

Conclusion:

Subretinal neovascularization presents a significant challenge in ophthalmology, with the potential to severely compromise vision. However, with advancements in diagnostic tools and therapeutic interventions, there's hope for patients. Early detection remains paramount, underscoring the importance of routine eye check-ups, especially for those at heightened risk. Through a combination of timely treatment and patient education, the progression of the disease can be mitigated, safeguarding vision and enhancing the quality of life.

Hashtags: #SubretinalNeovascularization #RetinalDisease #VisionCare #Ophthalmology #MacularDegeneration