Atrophic Scar from Resolved Choroidal Neovascularization (CNV)

An optometrist uploaded this case to Care1.

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An adult patient presented for a routine eye exam with no visual complaints and no previous records available. Anisocoria was noted in the left eye (OS) greater than the right (OD), with no relative afferent pupillary defect (RAPD). A suspicious area of retinal atrophy or scarring was noted superior to the optic nerve head (ONH) in the left eye. Macular epiretinal membrane (ERM) was present in both eyes. No OCT imaging was performed at the time of the exam.

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Note: A blurry area was observed over the superotemporal central retinal artery/vein, attributed to a linear floater artifact.

Care1 Retina Surgeon’s Clinical Insight

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This case represents old peripapillary choroidal neovascularization (CNV) in the left eye. Most CNV cases resolve on their own without treatment, often leaving behind a disciform scar. In this instance, the scar appears longstanding and inactive, with no signs of fluid or hemorrhage. There are currently no concerns. The patient is advised to monitor vision changes using an Amsler grid. Continued observation and follow-up with the optometrist are recommended. Care1 OMDs will remain available for ongoing management through remote file and diagnostic reviews.

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Care1 AI’s Clinical Insight

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Peripapillary Choroidal Neovascularization (PP-CNV) is defined as choroidal neovascularization occurring within one disc diameter of the optic nerve head. It can be idiopathic or secondary to conditions such as age-related macular degeneration, angioid streaks, high myopia, or inflammatory chorioretinal diseases. The neovascular membrane originates from the choroid and may extend into the subretinal space, potentially causing fluid or hemorrhage. PP-CNV lesions are typically less aggressive than subfoveal CNV.