Longitudinal Characteristics of Choroidal Neovascular Membrane in Pediatric Patients

• Published in: American journal of ophthalmology Vol. 261; pp. 76 - 84
• Main Authors: Hoyek, Sandra, Lu, Yifan, Mukai, Shizuo, Patel, Nimesh A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2024
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.01.004

•The leading cause of pediatric choroidal neovascular membrane (CNVM) is idiopathic followed by inflammatory.•The most common first-line treatment was intravitreal of anti–vascular endothelial growth factor (anti-VEGF).•Average number of total anti-VEGF injections was 2.3, with a retreatment rate of 52.2%.•OCTA showed decrease in CNVM vessel density, vessel-length density, and height of RPED.
To report the clinical and imaging characteristics, including optical coherence tomography angiography (OCTA), and treatment outcomes of choroidal neovascular membranes (CNVMs) in children.
Retrospective clinical cohort study.
Thirty eyes from 25 children (56% girls) with CNVM from 2 centers were examined from 2005 to 2022. Clinical features, imaging findings, treatment regimens, and outcomes are described.
The most common causes of CNVM were idiopathic (48%) and inflammatory (20%). At diagnosis, most CNVMs were unilateral (80%), active (83.3%), and juxtafoveal (46.7%). Twenty-five eyes (83.3%) of 21 patients (84%) were treated. The most common first-line treatment was intravitreal injection of anti–vascular endothelial growth factor (anti-VEGF) (92%), with a retreatment rate of 52.2% at an average of 237 days. The average number of total injections per eye was 2.3. Injections were safely administered in the clinic (52.2%). A gain of 3 lines or 15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters was observed at final visit. The average duration of follow-up was 56.46 ± 42.51 months. No ocular or systemic complication related to treatment was reported. Sixteen eyes (64%) had OCTA images at both presentation and final visit, which showed a decrease in CNVM vessel density and vessel-length density, and in the height of retinal pigment epithelium detachment (RPED).
There are a variety of underlying etiologies for pediatric CNVMs, which are most often unilateral. Treatment with intravitreal anti-VEGF can be beneficial and does not often require frequent or chronic dosing. OCTA demonstrated a decrease in the CNVM vessel density and vessel-length density as well as in the height of RPED.