Idiopatic choroidal neovascularization in children

Abstract

Introduction: Choroidal neovascularization (CNV) involves the growth of new blood vessels that originate from the choroid through a break in the Bruch membrane into the sub–retinal pigment epithelium or subretinal space. In young patients CNV may arise in association with angioid streaks, inflammations, macular dystrophy and other disorders. In some cases, no specific cause can be identified, and these cases are known as idiopathic CNV. Idiopathic CNV is a disorder that primarily affecting patients younger than 50 years and it is a major cause of visual loss. Methods: Case series Results: 1st case. 8 years old boy complained of blurry vision of the right eye for about 2 months. His best corrected visual acuity (BCVA) (Snellen chart) in the right eye was 0.06 and 1.0 in the left eye. Patient had a prominent gray-brown lesion of right macula at funduscopy. Full blood tests to rule out inflammatory pathology were done in other hospital and were normal. Macular OCT showed area of hiperreflection. In OCT angiography: small hyperreflective lesion in deep and outer retina and choriocapillaris layers. The idiopatic CNV was diagnosed. Treatment with intravitreal vascular endothelial growth factors inhibitors (anti-VEGF) was started. In 1 month after Bevacizumab intravitreal injection CNV reduced, BCVA increased up to 0.3. The patient is still observed. There is no progression. 2nd case 15 years old teenager complained of sudden black spot in right eye vision field. His BCVA of the right eye was 0.2 and 1.0 of the left eye. Macular edema, pigmented area with intense haemorrhage were noticed during fundus examination in the right eye. Blood tests to rule out any inflammatory or coagulation pathology were normal. Right eye macular OCT: irregular retinal pigment epithelium and hyperreflection under the macula and hyporeflective area under the neurosensory retina. OCT-angiography: a small hyperreflective lesion in deep and outer retina and choriocapillaris layers. Fluorescein angiography (FA): small early hyperfluorescence with intense progressive leakage. OCT and FA allowed to suspect CNV. The idiopatic CNV was diagnosed. It was decided to start treatment with intravitreal anti-VEGF Bevacizumab. During treatment it was used 3 intravitreal injections. His right eye BCVA increased till 0.9. There was no progression, subretinal hyporeflective area has gone on OCT. Conclusion: Early anti-VEGF treatment can stop idiopathic CNV progression and improve better results.