A single injection of intravitreal ranibizumab in the treatment of choroidal neovascularisation secondary to optic nerve head drusen in a child

Alkın, Zeynep; Özkaya, Abdullah; Yılmaz, İhsan; Yazıcı, Ahmet

doi:10.1136/bcr-2014-204456

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…Successful treatment of optic disc drusen with CNVM has been reported with surgery, 123; 200 laser photocoagulation, 38 photodynamic therapy, 29; 193 and more recently intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents. 2; 9; 37; 69; 84; 99; 175 Both bevacizumab and ranibizumab have been used successfully in children with CNVM secondary to optic disc drusen as young as five years of age. 9; 99 Although some clinicians use anti-VEGF agents to treat infants with retinopathy of prematurity, concerns still exist regarding the safety of these drugs, particularly bevacizumab, in the pediatric population.…”

Section: Treatmentmentioning

confidence: 99%

Optic disk drusen in children

Chang

Pineles

2016

Survey of Ophthalmology

112

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Optic disc drusen occur in 0.4% of children and consist of acellular intracellular and extracellular deposits that often become calcified over time. They are typically buried early in life and generally become superficial, and therefore visible, later in childhood, at the average age of 12 years. Their main clinical significance lies in the ability of optic disc drusen, particularly when buried, to simulate true optic disc edema. Misdiagnosing drusen as true disc edema may lead to an invasive and unnecessary workup for elevated intracranial pressure. Ancillary testing, including ultrasonography, fluorescein angiography, fundus autofluorescence, and optical coherence tomography, may aid in the correct diagnosis of optic disc drusen. Complications of optic disc drusen in children include visual field defects, hemorrhages, choroidal neovascular membrane, non-arteritic anterior ischemic optic neuropathy, and retinal vascular occlusions. Treatment options for these complications include ocular hypotensive agents for visual field defects and intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for choroidal neovascular membranes. In most cases, however, children with optic disc drusen can be managed by observation with serial examinations and visual field testing, once true optic disc edema has been excluded.

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Section: Treatmentmentioning

confidence: 99%

Optic disk drusen in children

Chang

Pineles

2016

Survey of Ophthalmology

112

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“…Knape et al reported rapid and atraumatic resolution with the combination of bevacizumab and focal laser photocoagulation [12]. Alkın et al emphasized that CNV secondary to ODD might be more sensitive than CNV secondary to age-related macular degeneration (AMD) in cases injected with a single dose of ranibizumab [13]. We achieved rapid response and did not observe recurrence in cases injected with 3 doses of aflibercept in the right eye and a single dose 2…”

Section: Discussionmentioning

confidence: 62%

Optic Coherence Tomography Angiography Findings of Bilateral Choroidal Neovascularization Associated with Optic Disc Drusen Treated with Intravitreal Aflibercept Injection

Akıdan¹,

Bulut

Yaprak

et al. 2020

Case Reports in Ophthalmological Medicine

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Purpose. The purpose of this case report is to present the findings of optical coherence tomography angiography (OCTA) of a patient with bilateral choroidal neovascularization (CNV) associated with optic disc drusen (ODD), who was treated with intravitreal aflibercept injection. Case presentation. A 14-year-old girl presented with a complaint of visual loss and metamorphopsia in her both eyes. Best-corrected visual acuity (BCVA) was 20/32 and 20/25, respectively, in the right and left eyes. Intraocular pressure and anterior segment examination were normal. Dilated fundus examination revealed elevated optic discs with blurred margins in both eyes. In addition, slightly elevated yellow lesion extending from optic nerve head to the macula was observed bilaterally. The patient underwent imaging with colour fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), spectral-domain optic coherence tomography (SD-OCT), OCTA, orbital ultrasonography (USG), and computed tomography (CT). In particular, OCTA demonstrated clearly the large circular CNV complex in the right eye and the CNV structure in the left eye containing slightly activated main trunk and minimal vessel loops in the papillomacular region. CNV secondary to bilateral ODD was suspected. Intravitreal aflibercept injections were performed in 3 doses to the right eye and a single dose to the left eye. After the injections, BCVA reached its complete level in both eyes. SD-OCT revealed irregularity of RPE in the temporal region of the optic disc and complete regression of the subretinal fluid. Interestingly, the entire CNV complex including the main trunk completely disappeared in OCTA. CNV complex was not observed in OCTA during 1-year follow-up, and peripapillary and macular vascular density measurements did not show any significant change. BCVA was preserved, and no additional injections were needed. Conclusion. It is possible that OCTA can be used for detailed evaluation of CNV associated with ODD, response to anti-VEGF treatment, and peripapillary and macular vascular density. There is a need for further studies to confirm the changes such as disappearance of CNV in OCTA after injection as we observed in our patient.

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“…Recently, anti-VEGF agents have been increasingly used as the first line treatment for CNV in paediatric cases 12. Several cases have been reported in the literature describing the successful use of anti-VEGF agents including intravitreal ranibizumab and bevacizumab for the treatment of CNV associated with optic disc drusen in childhood 2–8. We report the first case in the literature of a successful treatment using the newer intravitreal agent, aflibercept.…”

Section: Discussionmentioning

confidence: 94%

“…In recent years, several case reports2–8 have been published illustrating the successful use of anti-vascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab and bevacizumab, for the treatment of PPCNV secondary to optic disc drusen in children. We report the first case of successful treatment using the newer intravitreal therapy, aflibercept.…”

Section: Introductionmentioning

confidence: 99%

Paediatric case of peripapillary choroidal neovascularisation associated with optic disc drusen treated with aflibercept

Gan

Long

2019

BMJ Case Rep

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Peripapillary choroidal neovascularisation (PPCNV) associated with optic disc drusen is a rare complication that can result in severe vision impairment in children. We report the first case of paediatric PPCNV secondary to optic disc drusen successfully treated with intravitreal aflibercept. A 6-year-old girl presented with a one week history of reduced vision in her right eye with best-corrected visual acuity of 20/500. Fundus examination revealed bilateral elevated discs with a peripapillary pigmentary lesion in the right eye. Optical coherence tomography of the right eye showed marked subfoveal fluid. Both B-scan ultrasonography and fundus autofluorescence demonstrated findings consistent with optic disc drusen. Diagnosis of PPCNV was further confirmed on fluorescein fundus angiography. The child received three intravitreal aflibercept injections with complete resolution of the subfoveal fluid. Her visual acuity improved to 20/25 with no recurrence at a 16-month follow-up. No adverse side effects were reported.

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A single injection of intravitreal ranibizumab in the treatment of choroidal neovascularisation secondary to optic nerve head drusen in a child

Cited by 12 publications

References 9 publications

Optic disk drusen in children

Optic disk drusen in children

Optic Coherence Tomography Angiography Findings of Bilateral Choroidal Neovascularization Associated with Optic Disc Drusen Treated with Intravitreal Aflibercept Injection

Paediatric case of peripapillary choroidal neovascularisation associated with optic disc drusen treated with aflibercept

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