Peripapillary Choroidal Neovascularization Associated with Optic Nerve Head Drusen Treated with Anti-VEGF Agents

Saffra, Norman; Reinherz, Benjamin

doi:10.1159/000375480

Cited by 11 publications

(5 citation statements)

References 11 publications

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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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Section: Treatmentmentioning

confidence: 99%

Optic disk drusen in children

Chang

Pineles

2016

Survey of Ophthalmology

112

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“…CNV associated with ODD is a very rare complication, which has been reported in both adults and children [6]. In most of the patients, CNV membranes associated with ODD occur nasally; however, they may also occur temporally resulting in serous haemorrhagic maculopathy, cystoid macular edema, and macular scarring [7].…”

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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“…Treatment with anti-VEGF agents typically involves regular injections into the eye. The frequency of injections and the duration of treatment may vary depending on the individual case and the response to the medication [7]. Similar to previous treatment modalities, PCNV responds to intravitreal bevacizumab with a reduction in retinal fluid and improvement or preservation of vision [3].…”

Section: Table 2: Ophthalmological Examination After Receiving the Tr...mentioning

confidence: 95%

Peripapillary Choroidal Neovascular Membrane: A Case Report

Alojair,

Amer,

Alkhathami

et al. 2024

Cureus

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Peripapillary choroidal neovascular membrane (PCNM) is an abnormal growth of blood vessels beneath the retina near the optic disc. We report a case of a 60-year-old Saudi female with a history of hypertension, hypothyroidism, and epilepsy who presented to the emergency room (ER), reporting a sudden decrease in vision over the past month. Ophthalmic examination revealed reduced visual acuity. The patient received aflibercept via intravitreal injection every four weeks. On follow-up, she reported improvement in symptoms. It has been shown that intravitreal anti-vascular endothelial growth factor (VEGF) not only preserves visual acuity but also produces anatomic improvement when used alone or in conjunction with other therapeutic modalities like photodynamic therapy, laser photocoagulation, and subretinal surgery, as PCNM is aberrant blood vessel growth under the retina. Only a few cases have been recorded in Saudi Arabia; we report this case to emphasize the importance of diagnosis and timely treatment with anti-VEGF.

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Peripapillary Choroidal Neovascularization Associated with Optic Nerve Head Drusen Treated with Anti-VEGF Agents

Cited by 11 publications

References 11 publications

Optic disk drusen in children

Optic disk drusen in children

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

Peripapillary Choroidal Neovascular Membrane: A Case Report

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