Abstract
Purpose :
Multicenter evaluation of the clinical characteristics, treatment modalities and outcomes of pediatric choroidal neovascular membranes (CNVM).
Methods :
Retrospective case series of all patients 18 years old or less diagnosed with CNVM. Statistical tests were 2-tailed and significance was defined as P < 0.05. Stata version 9.0 (StataCorp, LP, College Station, TX) was used for statistical analyses.
Results :
Forty six eyes of 37 patients (16 Male, 21 Female) with a mean age of 11.1 years were analyzed. CNVM was associated with Best vitelliform macular dystrophy (n=14), idiopathic (n=12), post inflammatory (n=4), coloboma (n=4), optic nerve head drusen (n=3), myopia (n=3), choroidal rupture (n=1), persistent fetal vasculature syndrome (n=1), familial exudative vitreoretinopathy (n=1), and choroidal osteoma (n=1). 75% (n=28) of patients had unilateral disease. Presenting visual acuity ranged from count fingers to 20/25. The most common location was subfoveal (56.5%), followed by peripapillary (30.8%), juxtafoveal (13.0%), and extrafoveal (10.9%) (P < 0.001). Fluorescein angiography showed lesions to be classic (90.9%; P < 0.001) in the majority of cases. Optical coherence tomography (OCT) showed mainly type 2 CNVM (76.1%; P < 0.001).
Initial treatment modalities were anti-vascular endothelial growth factors (VEGF) (n=30; 90.9%) or laser (n=3; 9.1%). Bevacizumab was used predominantly (n=20). Anti-VEGF treatment was used alone (n=25), followed by an alternate anti-VEGF agent (n=3) or in combination with laser (n=1) or PDT (n=2). Nineteen eyes (63.3%) showed regression with anti-VEGF treatment alone with a mean of 2.1 (range 1-10) injections. Recurrences occurred in 7 eyes (21.2%) with an average of 1.1 recurrences per eye. Three of these eyes stabilized with repeat anti-VEGF therapy, while the remainder required photodynamic therapy (PDT), laser or surgery (n=1).
Conclusions :
This is the largest reported study on pediatric CNVM. Anti-VEGF therapy was effective with a low recurrence rate.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.