Optic disc neovascularization in inflammatory eye diseases: A review of pathogenesis, clinical features, and management

To review the pathogenesis, clinical presentation, and management of inflammatory optic disc neovascularization (ODN). ODN is a rare but vision-threatening complication of uveitis. Traditionally associated with retinal ischemia, recent evidence shows that ODN can arise even in well-perfused eyes, driven by chronic inflammation. A total of 102 reported cases of ODN in uveitic eyes without angiographic evidence of retinal ischemia were reviewed, analysing the underlying conditions, anatomical patterns, complications, and therapeutic responses. The optic disc was the exclusive site of neovascularization, often linked to prolonged inflammation. Diagnosis relied on angiographic and OCT-A imaging. Anti-inflammatory treatment was the cornerstone, with corticosteroids and immunosuppressants showing good efficacy. Anti-VEGF agents offered adjunctive benefits, especially in acute or haemorrhagic cases. An illustrative case of acute anterior uveitis with isolated ODN is presented; the neovascularization resolved after combined steroid and anti-VEGF therapy. ODN may emerge as a complication of uveitis even in the absence of ischemia. Recognizing its inflammatory nature is essential for appropriate treatment and to prevent vision-threatening sequelae.