Abstract
Purpose :
To document the imaging findings, clinical course, and response to treatment in children with choroidal neovascularization (CNV). CNV is a rare cause of vision loss in children, and there exist only a handful of studies describing the spectral domain optical coherence tomography findings and treatment outcomes of CNV in the pediatric population.
Methods :
This was a retrospective review of all children ≤ 18 years of age with CNV treated with at least one intravitreal bevacizumab injection from 1/1/2010 to 8/31/2017 at Children’s Hospital Los Angeles (CHLA). Twenty eyes of 18 patients met the inclusion criteria. All patients underwent intraoperative handheld spectral domain-optical coherence tomography (HHSD-OCT) (Bioptigen, Durham, NC) and intravitreal bevacizumab injection. The clinical data was collected and OCT measurements were performed, including central retinal thickness (CRT), maximal height of subretinal fluid (SRF), and maximal height of pigment epithelial detachment (PED). This study was approved by the CHLA IRB (IRB# CHLA-17-00425).
Results :
20 eyes of 18 pediatric patients with a mean age of 5.3 years (range: 2.3-18) and a mean follow up of 21.5 months (range: 3-70) were included. The most common causes of CNV were idiopathic (10/20; 50%), choroidal osteoma (3/20; 15%), and Coats disease (2/20; 10%). The median number of intravitreal bevacizumab injections received was 1 (range: 1-53) with a mean interval between injections of 2.93 months (range: 1-36). There was no significant difference at presentation versus at last follow up in CRT (290 vs. 330 μm; p>0.05), maximal SRF height (330 vs. 330 μm; p>0.05), or maximal PED/CNV height (146 vs. 212 μm; p>0.05). There were no complications such as retinal detachment, cataract, endophthalmitis, or sterile uveitis that arose from a total of 100 injections performed.
Conclusions :
Hand-held spectral-domain OCT is a useful adjunct to gauge treatment response to anti-vascular endothelial growth factor (VEGF) therapy in children with CNV. Although anti-VEGF therapy may stabilize the anatomical manifestations of CNV, improvements were not observed. Future studies should address whether this is due to underlying disease characteristics or to under-treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.