Wound healing research may hold clues to CNV beyond angiogenesis

Viable treatment options for choroidal neovascularization may be found beyond anti-angiogenic therapies, two surgeons from the United Kingdom suggest. Attention to the scarring response in the submacular tissue may provide a better overall strategy for combating CNV, they propose.

David Kent and Carl Sheridan note that CNV, at the cellular level, appears to be a part of “several key processes that can be broadly referred to as wound healing or tissue repair.” Angiogenesis is only one component of the wound healing process. In a review article in Molecular Vision, the two physicians addressed the “non-vascular components to highlight a condition that is essentially a submacular wound healing response.”

Regardless of the etiology of CNV, the authors said, both the cellular and extracellular constituents of the neovascularization appear to be similar. The wound healing response — in this case to the macula — is characterized by a typical early inflammatory response and tissue formation, a prominent angiogenic response and an end stage.

CNV formation is “often clinically underdiagnosed in age-related macular degeneration,” the authors said, as the basal laminar deposit can mimic Bruch’s membrane and enable CNV development and maturation that can support both the retinal pigment epithelium (RPE) and photoreceptors.

“This form of wound repair with angiogenesis is desirable, however it is the subsequent protracted scarring response that irreversibly compromises the photoreceptors and RPE that highlights the need to treat CNV with therapies other than just anti-angiogenesis approaches,” the authors said in the December issue.

The authors concluded by noting that “at the cellular level, both CNV and wound healing share an indisputable commonality,” thereby raising the possibility of treatment options outside angiogenic therapies.