Outcomes of Treatment of Pediatric CNV with Intravitreal Anti-angiogenic Agents: The Results of The KKESH International Collaborative Retina Study Group

Abstract

 

Purpose

 

To evaluate safety and clinical results after the use of intravitreal anti-angiogenic agents for the treatment of choroidal neovascularization (CNV) in pediatric patients.

 

Methods

 

Retrospective multicenter study of a total of 45 eyes of 39 pediatric patients with CNV who were treated with intravitreal injection of anti-angiogenic agents (1.25 mg/0.05 ml bevacizumab [40 eyes] or 0.5 mg/0.05 ml ranibizumab [5 eyes]). Choroidal neovascularization due to various causes was clinically diagnosed and confirmed with imaging studies.

 

Results

 

There were 24 females and 15 males with group median age 13 years (range 3-17 years). Mean follow-up period was 12.8 months (range 3-60 months). The etiology of the CNV included idiopathic, uveitic, myopic CNV, and CNV associated with various macular dystrophies. Median logMAR visual acuity at presentation and last follow-up was 0.87 (Snellen equivalent 20/150) and 0.7 (Snellen equivalent 20/100), respectively which was statistically significant (p=0.0003). Mean and median number of injections received over the follow-up period was 2.2 and 1, respectively. At the last follow-up, 22 eyes of this group (48%) gained more than 3 lines of vision and 27 eyes (60%) had final visual acuity 20/50 or better. Nine eyes (20%) did not improve and had severe vision loss (20/200 or worse).

 

Conclusions

 

Intravitreal anti-angiogenic therapy for CNV in pediatric patients seems temporarily safe and effective in the majority of affected eyes. Due to the rarity and character of this condition, it is unlikely that any clinical trials will soon take place to study this or other treatment option.

 

 

Early frame fluorescein angiogram (left) shows macular lesion with surrounding hypofluorescence and additional hyporeflective foci superotemporally (white arrow). Late frame shows staining of the macular lesion, dark hypofluorescence of the surrounding ring and hypofluorescent foci of the additional superotemporal lesions (right).

 

Keywords: 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 561 injection • 700 retinal neovascularization