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Bradley Anderson, Tapas R Padhi, Ashkan Abbey, Yoshihiro Yonekawa, Kimberly A Drenser, Antonio Capone, Jr., Michael Thomas Trese, Cagri G Besirli; Multicenter Evaluation of Pediatric Choroidal Neovascular Membrane: Clinical characteristics and treatment outcomes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2136. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Multicenter evaluation of the clinical characteristics, treatment modalities and outcomes of pediatric choroidal neovascular membranes (CNVM).
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.
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).
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.
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