title: Diagnostic Challenges in Inflammatory Choroidal Neovascular Membranes.
abstract: OBJECTIVE
  To describe the clinical presentations of inflammatory choroidal neovascular membranes (CNVMs) and factors leading to their delayed diagnosis.
  
  
  METHODS
  Retrospective analysis of chart records and digital images of 60 patients (73 eyes) with inflammatory CNVM (January 1998 to December 2013) to obtain demographic and clinical details, particularly the time of the first documentation of inflammatory CNVM by the uveitis specialist, time of its actual appearance on digital images, and the earliest clinical indicators of a CNVM.
  
  
  RESULTS
  In total, 14 (19.2%) eyes had a delayed diagnosis of inflammatory CNVMs, of which five developed significant visual loss. The earliest clinical indicators of CNVM that were overlooked initially due to their subtle appearance, included a tiny subretinal hemorrhage (five eyes), peripapillary halo/fluid/scar (eight eyes), and a subfoveal scar (one eye). The causes of uveitis in these eyes included Vogt-Koyanagi-Harada disease (five eyes, 35.7%), tubercular uveitis (five eyes, 35.7%), idiopathic (three eyes, 21.4%), and sympathetic ophthalmia (one eye, 7.1%). Presence of significant background fundus scarring, sunset glow fundus, visually significant cataract, poorly dilating pupil, media haze due to vitritis, cystoid macular edema, and multiple chorioretinal scars in these eyes probably predisposed to delayed detection of an underlying CNVM.
  
  
  CONCLUSIONS
  A high index of suspicion and comparison of serial fundus photographs to identify the earliest clues of inflammatory CNVMs are important to prevent diagnostic delays and poorer outcomes.
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Reema
authors.initials: R
authors.lastname: Bansal
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Bansal
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Amod
authors.initials: A
authors.lastname: Gupta
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Vishali
authors.initials: V
authors.lastname: Gupta
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Mangat R
authors.initials: MR
authors.lastname: Dogra
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Singh
authors.affiliation: a Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
authors.forename: Deeksha
authors.initials: D
authors.lastname: Katoch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D020256:Choroidal Neovascularization / Q000175:diagnosis*; D057210:Delayed Diagnosis; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014605:Uveitis / Q000175:diagnosis*; D014792:Visual Acuity; D055815:Young Adult
keywords: Bevacizumab; choroidal neovascular membrane; diagnosis; inflammation; uveitis