Ranibizumab for coloboma-related choroidal neovascular membrane in a child

Intravitreal ranibizumab for the management of serous maculopathy secondary to optic disc coloboma-associated choroidal neovascularisation

We report the case of a 19-year-old patient with symptomatic unilateral serous maculopathy associated with an optic nerve coloboma. Fluorescein angiography detected a focal late leak at the temporal edge of the coloboma which was later found to correspond with an area of choroidal neovascularisation on optical coherence tomography angiography. A course of intravitreal ranibizumab achieved good clinical and structural response. This report contributes to the evidence that maculopathies associated with cavitary optic nerve anomalies may in some instances result from choroidal neovascularisation. It also highlights the importance of angiography to identify potential choroidal neovascular membranes, particularly in the absence of haemorrhages and neovascular membranes on fundus examination and conventional optical coherence tomography.

Polypoidal Choroidal Vasculopathy Associated with Optic Disc Coloboma

Purpose

To report a case of polypoidal choroidal vasculopathy associated with optic disc coloboma.

Methods

Case report.

Results

A 50-year-old woman presented with optic disc coloboma and retinochoroidal coloboma associated with subretinal hemorrhage and serous retinal detachment (SRD) in her left eye. Optical coherence tomography (OCT) confirmed SRD at the macula and showed a sharply elevated retinal epithelial detachment at the choroidal excavation. OCT also revealed choroidal cavitation along the temporal side of the optic coloboma. Fluorescein angiography showed hyperfluorescent dye leakage and indocyanine green angiography revealed polypoidal lesions. We diagnosed polypoidal choroidal vasculopathy (PCV). PCV was located at the end of the choroidal cavitation. Her left eye was treated with an intraocular injection of the anti-vascular endothelial growth factor aflibercept (2 mg). Photodynamic therapy was performed using the standard protocol 1 week after the intravitreal application of aflibercept. One month after the combined treatment, OCT showed completely resolved SRD and her symptoms disappeared. Her best-corrected visual acuity remained stable and no recurrence was found during a 12-month follow-up period.

Conclusion

PCV associated with optic disc coloboma has not been previously reported. The morphological abnormality of choroidal cavitation and choroidal excavation connecting with optic disc coloboma may contribute to the development of PCV in this case.

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

PURPOSE

To describe the characteristics of pediatric choroidal neovascular membranes (CNVs) 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 of age with CNV and retinochoroidal and optic nerve coloboma from 1995-2015 who underwent OCT imaging using either handheld (Bioptigen, Morrisville, NC) or tabletop 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-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, CNVs were located at the temporal margin of the coloboma closest to the 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, 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 the 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.

Chorioretinal Coloboma Complications: Retinal Detachment and Choroidal Neovascular Membrane

Purpose:

To report the chorioretinal coloboma, and its association with increased risk of retinal detachment (RD) and choroidal neovascularization (CNV).

Methods:

This retrospective case series included eyes with chorioretinal coloboma diagnosed between 1995 and 2014 with a focus on RD and CNV as related complications. Cases of CNV were managed with laser photocoagulation or intravitreal injection of bevacizumab. For eyes with CNV, therapeutic success was defined as resolution of the subretinal hemorrhage on fundus examination and resolution of the subretinal and intraretinal fluid on optical coherence tomography (OCT). For eyes with RD, anatomic success following surgical intervention was defined as attachment of the retina at the last follow-up visit.

Results:

Fifty-one eyes of 31 patients with chorioretinal coloboma were identified for review. Bilateral chorioretinal coloboma was present in 64.5% of subjects. RD developed in 15 eyes (29.4%). Among 15 eyes with RD, 4 eyes (27%) had retinal breaks identified within the coloboma, 5 eyes (33%) had retinal breaks outside the coloboma, 2 eyes (13%) showed retinal breaks both inside and outside the coloboma, and in 4 eyes (27%) the causative retinal break was not localized. The overall rate of anatomic success after RD repair was 85.7%. CNV developed in 7 eyes (13.7%) and was located along the margin of the coloboma in all cases. CNV was bilateral in 2 of the 5 affected individuals (40%).

Conclusion:

RD and CNV were present in a high percentage of eyes with chorioretinal coloboma in these series. The frequent finding of retinal breaks outside the coloboma bed suggests that vitreoretinal interface abnormalities may play a role in development of RD in these eyes.

Antivascular Endothelial Growth Factor Monotherapy for Choroidal Neovascularization Associated With Retinochoroidal Coloboma: Case Series

PURPOSE

This study aimed to report the outcomes of antivascular endothelial growth factor (anti-VEGF) monotherapy for choroidal neovascularization (CNVM) associated with retinochoroidal coloboma (RCC).

DESIGN

A retrospective case series.

METHODS

This was a case series of 3 eyes with CNVM associated with RCC that presented to the LV Prasad Eye Institute, Hyderabad, India, between January 2006 and January 2014. Reported data included demographics, preoperative details (symptoms, duration of symptoms, and visual acuity), treatment methods, and postoperative details (visual acuity, follow-up, and recurrence). These data were compared with 9 other cases previously reported in the literature.

RESULTS

Three eyes of 3 patients (2 females and 1 male) were included, with a mean age of 18.3 years (range, 2-32 years). The preoperative best corrected visual acuity ranged from 20/540 to 20/100. All 3 eyes were treated with intravitreal bevacizumab injections. The mean number of injections was 2.0 (range, 1-3) and mean duration of follow-up was 12 months (range, 4-24 months) with no recurrence. The best corrected visual acuity at the last follow-up was improved, ranging from 20/310 to 20/60.

CONCLUSIONS

In view of good treatment outcomes with no recurrence and a lesser number of injections, anti-VEGF monotherapy could be considered as treatment for coloboma-associated CNVM.

Long-term results of intravitreal ranibizumab for osteoma-related choroidal neovascularization in a child

Though choroidal osteoma is a rare benign tumor, associated choroidal neovascularization (CNV) can be a cause of severe visual loss. A nine-year-old boy presented with one-month history of decreased vision in left eye. Upon a complete ophthalmologic examination, including fundus fluorescein angiography and optical coherence tomography, he was diagnosed with choroidal osteoma-related subfoveal CNV in the left eye. The CNV was associated with subretinal hemorrhage, subretinal fluid, and cystoid macular edema. Owing to the young age and subfoveal localization of the CNV, intravitreal ranibizumab injection was performed on this patient after a detailed discussion with the parents of its safety profile. No local or systemic complications were noted. No recurrence of CNV lesion was noted during 30 months of follow-up, and the vision was maintained. This report shows the favorable outcome of intravitreal injection of ranibizumab in choroidal osteoma-related CNV in a child.

Intravitreal bevacizumab in choroidal neovascularization associated with congenital choroidal and optic nerve coloboma in children: long-term improvement in visual acuity

Choroidal neovascular membranes are a rare cause of decreased vision in children with congenital choroidal and optic nerve colobomas. We report on the regression of coloboma-related choroidal neovascular membranes in 2 children treated with intravitreal bevacizumab. Visual acuity remained improved in both children 2 years after the last injection.