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R. M. Portela, J. E. Kempton, A. J. Daccache; Intravitreal Ranibizumab Treatment of a Pediatric Traumatic Choroidal Neovascular Membrane. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2719.
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To report a case of a pediatric traumatic choroidal neovascular membrane (CNVM) following blunt trauma successfully treated with a single intravitreal ranibizumab injection.
Description of an eight year old boy with progressive decrease in visual acuity for six months who had sustained blunt trauma to the left eye with a baseball one year prior to the onset of symptoms. Snellen visual acuity (VA), fundus ophthalmoscopy, fluorescein angiography (FA), and optical coherence tomography (OCT) were documented prior to treatment. The patient was subsequently treated with a single off-label intravitreal ranibizumab injection. VA and fundus ophthalmoscopy were repeated at 3 weeks, two months, and four months following treatment. The OCT was repeated at 2 months.
Prior to treatment, the VA was hand motion at one foot and the fundus exam showed a concentric area of peripapillary fibrosis with associated exudates, hemorrhages, and edema. The FA showed staining with associated late leakage mirroring the fibosis on exam and the OCT demonstrated subretinal fluid (SRF) and cystic macular edema greater than 600 microns in the foveal area. The 3 week, 2 month and 4 month visual acuities were 20/200, 20/60, and 20/50, respectively. The fundus exam showed complete resolution of the edema leaving only a small scar with fibrosis in the peripapillary region. The OCT repeated at 2 months showed resolution of the SRF with only the fibrotic scar remaining.
We describe the first case of a successful single intravitreal ranibizumab injection in a pediatric traumatic CNVM. This injection of ranibizumab resulted in complete resolution of the CNVM, improvement of VA, and no evidence of recurrence for six months. Intravitreal ranibizumab injection may be an effective and safe treatment option for traumatic choroidal neovascular membranes. Further studies addressing the safety and efficacy of this treatment in the pediatric population are warranted.
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