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

Abstract

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.

Clinical Features of Pediatric Choroidal Neovascularization and Outcomes of Treatment with Intravitreal Anti-VEGF in Korean Patients

“…In one case report, two Korean patients with pediatric CNV were treated with ranibizumab [19]. Recently, one study of Chinese patients with pediatric CNV was conducted [6]. No other studies on CNV in East Asian pediatric patients have been conducted.…”

“…Anatomical characteristics such as central macular thickness (CMT) and distribution of fluid were evaluated through OCT. CMT was defined as the mean retinal thickness in the 1 mm zone. The presence of intraretinal cystoid fluid, subretinal hyper-reflective material, and subretinal fluid (SRF), biomarkers that reflect prognosis, was assessed [6]. If hemorrhage or OCT biomarkers were observed, CNV was considered active.…”

“…Also, because CNV occurs at a young age, the disability-adjusted life years of pediatric patients are greater than those of adults with CNV [5]. Additionally, young children may have no symptoms or complaints of discomfort, hindering early diagnosis [6]. Also, implementing an evidence-based treatment protocol for treatment of pediatric CNV is challenging due to the rarity of the disease [3,7].…”

“…Several treatment methods have been introduced for pediatric CNV [8][9][10], but the recent therapeutic paradigm is shifting toward the use of anti-vascular endothelial growth factor (VEGF) [11]. Several studies have reported the usefulness of anti-VEGF in pediatric CNV, but most are retrospective case series reports [2,4,6,7,11,12], and studies in Asian patients are few [6,13]. Recently, a study on pediatric CNV patients using a large database was reported [14].…”

„Dome-shaped maculopathy“ bei einem 11-jährigen Kind

“…Um bei Verlaufskontrollen weiterhin eine myope CNV auszuschließen, ist die OCT-Angiographie notwendig, in einigen Fällen kann eine Fluoreszenzangiographie angebracht sein. Bei aktiver CNV kann auch bei Kindern eine Therapie mit Anti-VEGF in Erwägung gezogen werden [14].…”