Pediatric choroidal neovascularization: Etiology and treatment outcomes with anti-vascular endothelial growth factors

Abstract

Purpose: To describe the etiology and treatment outcomes of choroidal neovascularization (CNV) in a pediatric population with intravitreal anti-vascular endothelial growth factors (VEGF) Methods: Retrospective single center interventional case series. A total of 26 eyes of 23 consecutive pediatric patients with CNV of various etiologies were treated with intravitreal injection of anti-VEGF agents. Results: There were 15 males (65.2%) and eight females (34.8%), diagnosed with CNV during the study period. The mean age at presentation with CNV was 11.7 ± 3.3 years, (range 4–16 years) and the mean follow was 28.1 ± 18 months, (range 8–72 months). Inflammatory CNV was the most common etiology. The mean best corrected visual acuity (BCVA) and mean central macular thickness (CMT) at presentation, were logMAR 0.8 ± 0.3 and 367.6 ± 134.8 µm respectively. At the final visit, CNV in all eyes remained regressed with significant improvement in mean BCVA to logMAR 0.4 ± 0.4 ( p < 0.0001) and mean CMT to 242.5 ± 82.4 µm ( p < 0.0001). A mean of two intravitreal injections per eye was required for CNV regression. Conclusion: Intravitreal anti-VEGF therapy for pediatric CNV is an effective treatment in majority of affected eyes.

Unilateral macular neovascularization formation during the follow-up of a 15-year-old boy with Bietti crystalline dystrophy and the successful treatment outcome with a single intravitreal ranibizumab injection

“…MNV is a rare clinical finding in children that can cause significant visual impairment if left untreated [ 14 ], [ 15 ]. Posterior uveitis/post inflammation, retinal dystrophies, ocular trauma, neoplasms, pathological myopia and idiopathic variety are among the causes of pediatric MNVs and retinal dystrophies are present only in 11.5 [ 16 ] to 39.5% [ 17 ] of the pediatric cases. Best disease is the most common form of dystrophies in association with pediatric MNVs, and there are only anectodal case reports describing the MNV associated with BCD (Table 1 (Tab.…”

“…Intravitreal anti-VEGF administration is a viable treatment option in childhood MNVs despite being an off-label treatment and was previously reported in several retrospective clinical studies [ 14 ], [ 16 ], [ 17 ]. However, it is less convenient to perform intravitreal injections in pediatric age group as they can only be given under general anaesthesia as the administration in the present case.…”