Association of Pediatric Choroidal Neovascular Membranes at the Temporal Edge of Optic Nerve and Retinochoroidal Coloboma

• Published in: American journal of ophthalmology Vol. 174; pp. 104 - 112
• Main Authors: Grewal, Dilraj S., MD, Tran Viet, Du, BS, Vajzovic, Lejla, MD, Mruthyunjaya, Prithvi, MD, Toth, Cynthia A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017; Elsevier Limited
• Subjects: Angiogenesis Inhibitors - therapeutic use; Bevacizumab - therapeutic use; Child; Child, Preschool; Choroid - diagnostic imaging; Choroidal Neovascularization - diagnosis; Choroidal Neovascularization - etiology; Coloboma - complications; Coloboma - diagnosis; Female; Fluorescein Angiography - methods; Follow-Up Studies; Fundus Oculi; Humans; Infant; Male; Medical imaging; Membranes; Ophthalmology; Optic nerve; Optic Nerve - abnormalities; Optic Nerve - diagnostic imaging; Pediatrics; Retina; Retina - diagnostic imaging; Retrospective Studies; Time Factors; Tomography, Optical Coherence - methods; Vascular Endothelial Growth Factor A - antagonists & inhibitors
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2016.10.010

Abstract Purpose To describe the characteristics of pediatric choroidal neovascular membranes (CNV) associated with retinochoroidal and optic nerve coloboma using optical coherence tomography (OCT) and their response to treatment. Design Retrospective case series. Methods Retrospective review of children <16 years with CNV and retinochoroidal and optic-nerve coloboma from 1995-2015 who underwent OCT imaging using either hand-held (Bioptigen, Morrisville, NC) or table-top OCT (Spectralis, Heidelberg, Carlsbad, CA) Results Eight eyes of 8 patients (3 males, 5 females) with a mean age of 4.1±3.9 years (range 6-months to 10-years) at diagnosis were included. Mean follow-up was 21.4±12.1 months (range 7-38 months). An optic-nerve coloboma was present in 2 eyes and combined optic nerve and retinochoroidal coloboma in 6 eyes. In all eyes, CNV was located at temporal margin of the coloboma closest to macula. Fluorescein angiogram characteristics included staining without leakage suggesting inactivity (n=6), and leakage (n=2). OCT characteristics included subretinal fluid (n=5), intraretinal fluid and cysts (n=1) and subretinal hyperreflective material (n=7). Two eyes received intravitreal bevacizumab (range 3-6) injections, and one of which also underwent focal peripapillary laser. Both eyes showed improvement in subretinal or intraretinal fluid on OCT. Vision at presentation among those quantified, ranged from 20/200 to 20/40 and at final follow-up from 20/400 to 20/30. Genetic or systemic abnormalities were seen in 6 patients. Conclusions Association of pediatric CNV occurrence at the temporal margin of retinochoroidal and optic nerve colobomas closest to fovea has not been established before and careful OCT and angiographic assessment of this region is warranted. The CNV lesions exhibit a varied degree of response to treatment.