Choroidal neovascularization in 36 eyes of children and adolescents

Abstract

Purpose To describe the clinical features and outcomes among eyes with choroidal neovascularization (CNV) in children and adolescents. Methods A total of 36 eyes of 27 patients o18 years of age diagnosed with CNV between January 1978 and December 2008 were retrospectively reviewed. CNV was clinically diagnosed in all patients and its presence was confirmed by fundus fluorescein angiography (FFA). A total of 19 eyes underwent treatment. Anatomical outcome was evaluated as regressed/ persistent/recurrent CNV. Snellen's values for best corrected visual acuity (BCVA) were converted to logMAR for statistical calculations. Results Of the 27 patients, 17 (63%) were male. Nine (33.3%) of the 27 patients had bilateral CNV. At presentation, CNV was active in 22 (61.1%) eyes and regressed in 14 (28.9%) eyes. All active CNV cases were 'classic' type, with the majority (80.5%) being subfoveal. The mean greatest linear dimension (GLD) was 3.16 ± 1.94 mm (range, 0.9-10.15). The most common cause (41.7%) was post-inflammatory. The mean duration to regression in treated eyes was 103.53 days (15 eyes). Recurrence was noted in three (8.3%) eyes. The mean duration to first recurrence was 260 days (range, 90-390), and the mean follow-up duration was 779.53 ± 988.00 days. Conclusion CNV remains a cause of significant visual decline in children and adolescents. Male predominance, postinflammatory etiology, bilateral affection, and subfoveal location are noteworthy, with a high regression rate in response to treatment. Re-treatment is required in a limited number of cases.

Active surveillance of choroidal neovascularisation in children: incidence, aetiology and management findings from a national study in the UK

“…Previous papers report spontaneous regression in 58%26 and 41.7%2 of the eyes. A characteristic finding that may be predictive of regression is a pigmented ring or encapsulation around the lesion 27.…”

“…The disorder is rare with an annual incidence in the UK for those aged 16 and under of 0.21 per 100 000. Two retrospective studies of CNV in children younger than 18 years2 9 reported opposing gender preponderance, with Barth et al 9 reporting a strong female predominance (80%), in contrast to Rishi et al, 2 who described a higher male preponderance (63%). This result may be due to the different ethnic background and access to healthcare facilities.…”

“…Regarding the dosage, some studies use a standard adult dose of 1.25 mg/0.05 mL of bevacizumab or 0.5 mg/0.05 mL of ranibizumab22 as there is little difference in ocular volume between older children and adult eyes; preterm infants with a smaller ocular size require a lower dosage 23. The number of injections required to control the disease was lower compared with adults,3 and this was supported by the favourable course of CNV in younger subjects reported by Spaide,24 attributed to the better health of the retinal pigment epithelium (RPE) pump 2…”

Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to punctate inner choroidopathy

“…The recent establishment of intravitreal antiangiogenic treatment for CNV secondary to exudative age-related macular degeneration (AMD) has led to increasing reports of anti-VEGF (vascular endothelial growth factor) therapy for CNV of other causes than AMD and in younger populations [17][18][19]. However, due to the rarity of PIC-related CNV no evidence-based treatment protocol exists [1,13].…”

“…5 months on average (SD 5.5, range[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Although the eyes treated by ranibizumab (n = 2) had a slightly better functional outcome (DBCVA ?1.5 lines) compared to the eyes injected with bevacizumab (n = 13, DBCVA ?0.77 lines), no conclusion can be drawn about the superiority of one of the anti-VEGF agents because of the low sample sizes.Visual acuity, refraction and functional outcomeThe refractive error was recorded in 13 (81%) eyes with a mean spherical equivalent of -4.3 dioptres (D) (SD 3.1 D, range -7.0 to 0.5 D).…”