Bilateral choroidal neovascularization associated with optic nerve head drusen treated by antivascular endothelial growth factor therapy

Delás, Bárbara; Almudí, Lorena; Carreras, Anabel; Asaad, M.

doi:10.2147/opth.s22991

Cited by 25 publications

(17 citation statements)

References 16 publications

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“…No recurrence was observed during the follow-up period. Similar results have been reported in the literature 6 7. Gregory-Evans et al 6 used three monthly intravitreal ranibizumab injections to treat CNV secondary to ONHD in an 11-year-old boy.…”

Section: Discussionsupporting

confidence: 79%

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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

et al. 2014

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Optic nerve head drusen are acellular, calcified deposits which may be found in buried or exposed drusen form. Choroidal neovascularisation secondary to optic nerve head drusen is rarely seen in childhood. This case report summarises the clinical and therapeutic outcomes of a 13-year-old girl with unilateral choroidal neovascularisation secondary to optic nerve head drusen. The patient was successfully treated with a single intravitreal ranibizumab injection. After a month from the injection the visual acuity increased dramatically and maintained at the same level during 9 months of follow-up time. There was no complication related to the injection.

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Section: Discussionsupporting

confidence: 79%

“…They reported that subretinal fluid was disappeared and BCVA improved to 20/60 from hand movements. After 12 months’ of follow-up BCVA was 20/60 7. Knape et al 8 reported their successful treatment for CNV secondary to ONHD in a 5-year-old boy.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2014

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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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“…Possible mechanisms involved in this complication include the compressive effect of drusen on the surrounding blood vessels, which leads to mechanical impairment of peripapillary vascular integrity, vascular congestion, or ischemia. Retinal ischemia and the release of VEGF may be the factors that trigger the development of CNV [8,9]. Treatment must be provided if vision is jeopardized.…”

Section: Discussionmentioning

confidence: 99%

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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Bilateral choroidal neovascularization associated with optic nerve head drusen treated by antivascular endothelial growth factor therapy

Cited by 25 publications

References 16 publications

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

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

Optic disk drusen in children

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

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