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Tapas Padhi, Ashkan Abbey, Danish Alam, Rohit Modi, Kimberly A Drenser, Antonio Capone, Michael Thomas Trese, Cagri G Besirli; Choroidal neovascular membrane in pediatric subjects: Clinical characteristics and outcome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3855.
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© ARVO (1962-2015); The Authors (2016-present)
Paucity of published data on pediatric choroidal neovascular membrane (CNVM)s make the management of this entity challenging. We performed a retrospective, observational clinical study to describe the clinical and imaging findings and response to treatment at three high volume pediatric retina centers.
The charts of all patients of 18 years or less with a diagnosis of CNVM were reviewed. The demographic profile, laterality, presenting complaint, corrected vision, primary pathology, fundus examination, fundus fluorescein angiogram (FFA) and Optical coherence tomography (OCT) findings were analyzed. The type, frequency, indications of treatment, recurrences and final visual acuity were noted.
Out of 20 patients (25 eyes) 15 had unilateral and 5 had bilateral CNVM. The age ranged from 10.5 months to 18 (mean: 11.39) years with a male: female ratio of 1:1.5. The presenting vision ranged from finger count to 20/25.The etiology was idiopathic in 6 eyes; Best vitelliform macular dystrophy (4), uveitis (4), chorioretinal coloboma (2) pathological myopia (1), familial exudative vitreoretinopathy (1), traumatic choroidal rupture (1) and unknown macular dystrophy (1) accounted for the rest. Fourteen eyes received intravitreal bevacizumab (IVB), 4 eyes were lasered, one eye required surgery and photodynamic therapy in addition to IVB. Four patients (6 eyes) did not return for treatment. Among the treated eyes, the CNVM regressed in 9 eyes at final examination. There was an overall improvement in vision by 4 lines (1.074 to 0.6382 in log MAR). This was statistically significant (paired t-test, p=0.0361). While the minimum number of injection was 1, the maximum was 6 (avg. 3 per eye). Among those who received injection (15), 2 eyes with single recurrence were managed with repeat IVB while the other underwent submacular surgery and photodynamic therapy. Those lesions that were treated solely on the basis of angiogram even without clinical evidence of haemorrhage or fluid also showed improvement in visual acuity. No ocular or systemic adverse events were observed in any of our treated patients.
Next to idiopathic, Best disease appeared to be an important cause of CNVM in our series. Leakage in the angiogram was found to be an important predictor of the activity. There was statistically significant improvement in vision following treatment with bevacizumab.
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