Download Pediatric CNV – Dr. Denis Jusufbegovic

Retina Imaging Conference
Denis Jusufbegovic, M.D.
University of Louisville
Department of Ophthalmology and Visual Sciences
2/11/16
Case Presentation
CC: “ Left eye turning in x few weeks”
HPI: 5 yo boy was brought to clinic by parents who noticed that his left
eye was turning in for few weeks. No recent illness or trauma. Child
had no complaints. After evaluation by a pediatric ophthalmologist,
patient was referred to retina clinic.
Case Presentation
PMH: Negative, term-baby, vaccination up to date
POH:
None
FH:
Non-contributory
MEDS: None
ALL:
NKDA
ROS:
Negative
Case Presentation
OD
OS
20/400

BCVA:
20/20

Pupils:
4

IOP:

Anterior segment: normal
No APD
12 mmHg
4
12 mmHg
Fundus Photos
Right eye is normal. Color fundus photograph of the left eye demonstrates subfoveal hemorrhage..
Fluorescein Angiography
FA of the right eye is normal
Fluorescein Angiography
FA demonstrates subfoveal choroidal neovascularization in the left ye
OCT
Assessment
5 year-old boy with subfoveal choroidal neovascularization OS.
? Etiology
DDX
Trauma
Infection
Inflammation
Idiopathic
Management
Lab work: RPR negative, Toxocara IgG and IgM negative,
Toxoplasma IgG and IgM negative
Intravitreal Bevacizumab injection OS
Patching (2hrs/day) OD for deprivational amblyopia
Follow up
Initial visit
1 mo s/p Avastin
3 mo s/p Avastin #2
3 mo follow up
BCVA improved
to 20/100 OS
Pediatric CNV

Development of CNV in young children is rare

CNV lesions and their etiologies significantly differ between children and
adults

Most common causes of CNV in adults are AMD and high myopia,
which are generally not seen in children

CNV lesions in young children are focal and mostly located in subretinal
space (type 2 or classic membranes)
Pediatric CNV- Etiology

Inflammatory/infectious - most common cause of CNV in children (unclassified
focal choroiditis, POHS, toxoplasmosis, toxocara)

Retinal dystrophies - the second common cause identified in several case series was
Best’s disease Other dystrophies such as Stargardt disease, choroideremia, North Carolina
macular dystrophy may cause CNV

Idiopathic - large percentage of CNV lesions in children have no identifiable cause

Traumatic – choroidal rupture

Others – ON drusen, angioid streaks, choroidal osteoma, combined hamartoma of the
retina and RPE
Management

Anti-VEGF is the mainstay therapy for CNV
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•
•
•
•
•
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Retrospective review of 39 cases (45 eyes)
Majority treated with Avastin, few with Lucentis
Mean and median number of injections was 2.2 and 1
22 eyes (48%) gained more than 3 lines
27 eyes (60%) had final visual acuity 20/50 or better
(20%) did not improve and had severe vision loss (20/200 or worse)
No systemic side-effects reported
Kozak I et al. Outcomes of treatment of pediatric choroidal neovascularization with intravitreal antiangiogenic agents: the results of
the KKESH International Collaborative Retina Study Group. Retina. 2014 Oct;34(10):2044-52.
Thank you
References
1.
Rishi P, Gupta A, Rishi E, Shah BJ. Choroidal neovascularization in 36 eyes of children and adolescents. Eye (Lond). 2013 Oct;27(10):1158-68
2.
Kozak I et al. Outcomes of treatment of pediatric choroidal neovascularization with intravitreal antiangiogenic agents: the results of the KKESH
International Collaborative Retina Study Group. Retina. 2014 Oct;34(10):2044-52.
3.
Kohly RP et al. Management of pediatric choroidal neovascular membranes with intravitreal anti-VEGF agents: a retrospective consecutive case
series. Can J Ophthalmol. 2011 Feb;46(1):46-50
Wilson ME, Mazur DO. Choroidal neovascularization in children: report of five cases and literature review. J Pediatr Ophthalmol Strabismus.
1988 Jan-Feb;25(1):23-9. Review.
4.