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

Moosajee, Mariya; Abbouda, Alessandro; Foot, B; Bunce, Catey; Moore, Anthony T.; Acheson, James

doi:10.1136/bjophthalmol-2017-310445

Cited by 12 publications

(13 citation statements)

References 27 publications

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“…Anti-VEGF therapy seems to be well tolerated in children for the treatment of CNV with no reported adverse effects at 1-year follow-up based on recent studies 12 20. Similarly, there were no ocular or systemic complications reported in all cases including our patient for a follow-up period between 6 months and 5 years.…”

Section: Discussionsupporting

confidence: 66%

“…Optic disc drusen are now recognised as a common association with CNV in children. Studies have reported between 8%–18% of children with CNV have concommitant optic disc drusen 11 12. The location of subretinal CNV associated with optic disc drusen is usually peripapillary and can impair vision as a result of extension of subfoveal fluid 13…”

Section: Discussionmentioning

confidence: 99%

“…Historically, several treatment modalities have been proposed including observation,14 laser photocoagulation,15 photodynamic therapy16 17 and surgery,18 19 all with variable outcomes. 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.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Gan

Long

2019

BMJ Case Rep

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“…The most common cause of CNV is age-related macular degeneration, followed by pathologic myopia (1). However, in children and adolescents, the reasons related with CNV are diverse and the lesion have a severe impact on visual acuity and quality of life over patients' lifetime (2)(3)(4). Although the incidence of CNV is quite rare in children and adolescents, its impact in view of the number of blind years lived is tremendous (5).…”

Section: Introductionmentioning

confidence: 99%

“…In the pediatric population, CNV has been reported to be collected with myopia, infection, inflammation, congenital anomalies, retinal dystrophies, and may also be idiopathic ( 2 ). The management of CNV in the pediatric patient setting is challenging, and a number of options, such as observation, photodynamic therapy, laser photocoagulation and anti-vascular endothelial growth factor (anti-VEGF) treatment has been reported, variable visual outcomes has been observed ( 6 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

Choroidal Neovascularization in Pediatric Patients: Analysis of Etiologic Factors, Clinical Characteristics and Treatment Outcomes

et al. 2021

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Background and Objectives: Choroidal neovascularization (CNV) is a common pathologic lesion that occurs in various chorioretinopathy, but very limited published data have reported in pediatric patients. This study aimed to investigate the etiologic factors, clinical features, and treatment outcomes of choroidal neovascularization (CNV) in children.Methods: In this study, 33 eyes in 30 patients aged 18 years or younger with CNV were included. Comprehensive ophthalmic examination was performed in all the patients. The demographic profiles, laterality, visual acuity, optical coherence tomographic findings, fundus fluorescein angiographic findings, and the underlying pathology were analyzed. The types, locations, treatment outcomes, and recurrences of CNV were noted.Results: The average age was 11.2 ± 4.6 (range, 1–18) years. Most CNVs affecting children were classic and type 2. The most common etiologic factors of CNV in pediatric patients were congenital/developing abnormalities (9/30, 30.0%) and inflammatory retinochoroidopathy (9/30, 30.0%), followed by idiopathic CNV (8/30, 26.7%). Subtype analysis showed that the etiologic factor was inflammatory retinochoroidopathy in children 12 years or older, whereas congenital/developing abnormalities were present in children younger than 12 years. Eyes with active CNVs required a mean of 1.40 ± 0.58 injections. No recurrence was observed during follow-up.Conclusions: The etiologic factors of CNV in young Chinese patients were diverse, with congenital/developing abnormalities, inflammatory retinochoroidopathy and idiopathic CNV being the 3 most common ones. Eyes with active CNVs had good responses to antivascular endothelial growth factor treatment with low recurrence.

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Progression of retinal choroidal neovascularization by latent human cytomegalovirus infection and immunological signaling among neonatal patients admitted to tertiary care hospital

Roy,

Chatterjee,

Mishra

et al. 2024

Journal of Medical Virology

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Choroidal neovascularization (CNV) is a serious condition that affects the retina, causing partial or complete blindness in people of different ages. While CNV is a common occurrence in various chorioretinopathies, research on its occurrence in neonates is limited. Human cytomegalovirus (HCMV) is a significant health threat to neonates, with a strong association with retinal angiogenesis. However, there has been limited investigation into HCMV‐associated CNV progression. In this article, we extensively studied the expression of different inflammatory cytokines and chemokines during latent HCMV‐associated retinal neovascularization. Our research found that HCMV‐induced CNV progression was significantly prominent in the presence of AT2R‐dependent angiogenesis (p < 0.001), whereas in the absence of HCMV, AT1R‐dependent CCL‐5‐mediated angiogenesis was documented. We also observed significant increases in CCL‐19, CCL‐21 chemokine responses, followed by CCR‐7 chemokine receptor activation (p < 0.001) in HCMV‐induced CNV patients compared to HCMV non‐induced CNV groups. Furthermore, significant changes in predictive chemokine markers of HCMV‐induced CNV were positively correlated with HCMV viremia. These immunological alterations ultimately lead to the switching of NFκB canonical and noncanonical pathways, respectively, in HCMV‐induced neonatal CNV and HCMV non‐induced CNV. This clinical observation presents a novel hypothesis that ocular HCMV latency poses a noteworthy risk factor for the progression of retinal neovascularization through a distinctive immunological signaling pathway. The current study represents the first of its kind to report on this association, which may have significant implications for the clinical management of patients with ocular HCMV.

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

Abstract: This is the first population-based prospective study of CNV in children. This is a rare disorder with a poor visual prognosis irrespective of CNV location and the use of anti-VEGF therapy.

Cited by 12 publications

References 27 publications

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

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

Choroidal Neovascularization in Pediatric Patients: Analysis of Etiologic Factors, Clinical Characteristics and Treatment Outcomes

Progression of retinal choroidal neovascularization by latent human cytomegalovirus infection and immunological signaling among neonatal patients admitted to tertiary care hospital

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