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Hoyek S, Lu Y, Mukai S, Patel NA. Longitudinal Characteristics of Choroidal Neovascular Membrane in Pediatric Patients. Am J Ophthalmol 2024; 261:76-84. [PMID: 38195046 DOI: 10.1016/j.ajo.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE To report the clinical and imaging characteristics, including optical coherence tomography angiography (OCTA), and treatment outcomes of choroidal neovascular membranes (CNVMs) in children. DESIGN Retrospective clinical cohort study. METHODS Thirty eyes from 25 children (56% girls) with CNVM from 2 centers were examined from 2005 to 2022. Clinical features, imaging findings, treatment regimens, and outcomes are described. RESULTS The most common causes of CNVM were idiopathic (48%) and inflammatory (20%). At diagnosis, most CNVMs were unilateral (80%), active (83.3%), and juxtafoveal (46.7%). Twenty-five eyes (83.3%) of 21 patients (84%) were treated. The most common first-line treatment was intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) (92%), with a retreatment rate of 52.2% at an average of 237 days. The average number of total injections per eye was 2.3. Injections were safely administered in the clinic (52.2%). A gain of 3 lines or 15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters was observed at final visit. The average duration of follow-up was 56.46 ± 42.51 months. No ocular or systemic complication related to treatment was reported. Sixteen eyes (64%) had OCTA images at both presentation and final visit, which showed a decrease in CNVM vessel density and vessel-length density, and in the height of retinal pigment epithelium detachment (RPED). CONCLUSIONS There are a variety of underlying etiologies for pediatric CNVMs, which are most often unilateral. Treatment with intravitreal anti-VEGF can be beneficial and does not often require frequent or chronic dosing. OCTA demonstrated a decrease in the CNVM vessel density and vessel-length density as well as in the height of RPED.
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Affiliation(s)
- Sandra Hoyek
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Yifan Lu
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Shizuo Mukai
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimesh A Patel
- From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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Rohowetz LJ, Kunkler AL, Sengillo JD, Lazzarini TA, Lam BL, Berrocal AM. Choroideremia presenting as vision loss secondary to choroidal neovascularization. Ophthalmic Genet 2024; 45:175-179. [PMID: 37575054 DOI: 10.1080/13816810.2023.2245117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Choroidal neovascularization (CNV) is a rare complication of choroideremia that occurs secondary to relative atrophy of the retinal pigment epithelium and eventual rupture of Bruch's membrane. The ideal management of CNV in choroideremia is unclear. MATERIALS AND METHODS Case report. OBSERVATIONS A 14-year-old male with no known ocular history presented to the eye emergency department complaining of a central scotoma in the right eye for 4 days. He had no past medical history and family history was unremarkable for known ocular disease. Visual acuity was 20/70 in the right eye and 20/30 in the left eye. Posterior segment exam revealed chorioretinal atrophy extending from the outer macula to the midperiphery in both eyes. There was CNV with associated subretinal hemorrhage in the right eye. Optical coherence tomography demonstrated the presence of CNV with subretinal fluid in the right eye and parafoveal outer retinal atrophy in both eyes. Genetic testing revealed a hemizygous exon 2 deletion on the CHM gene, pathogenic for choroideremia. The patient received a total of 3 injections 4 weeks apart followed by 1 injection 6 weeks later with resolution of the subretinal hemorrhage and reduction in CNV size with improvement in visual acuity to 20/20 at last follow-up exam. CONCLUSIONS AND IMPORTANCE Choroidal neovascularization is a rare cause of central vision loss in patients with choroideremia. In this report, we demonstrate a good functional and anatomic response to intravitreal bevacizumab in a 14-year-old patient with undiagnosed choroideremia who presented with CNV-induced central vision loss.
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Affiliation(s)
- Landon J Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anne L Kunkler
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Thomas A Lazzarini
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Byron L Lam
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
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Zhang J, Sharma D, Dinabandhu A, Sanchez J, Applewhite B, Jee K, Deshpande M, Flores-Bellver M, Hu MW, Guo C, Salman S, Hwang Y, Anders NM, Rudek MA, Qian J, Canto-Soler MV, Semenza GL, Montaner S, Sodhi A. Targeting hypoxia-inducible factors with 32-134D safely and effectively treats diabetic eye disease in mice. J Clin Invest 2023; 133:e163290. [PMID: 37227777 PMCID: PMC10313368 DOI: 10.1172/jci163290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Many patients with diabetic eye disease respond inadequately to anti-VEGF therapies, implicating additional vasoactive mediators in its pathogenesis. We demonstrate that levels of angiogenic proteins regulated by HIF-1 and -2 remain elevated in the eyes of people with diabetes despite treatment with anti-VEGF therapy. Conversely, by inhibiting HIFs, we normalized the expression of multiple vasoactive mediators in mouse models of diabetic eye disease. Accumulation of HIFs and HIF-regulated vasoactive mediators in hyperglycemic animals was observed in the absence of tissue hypoxia, suggesting that targeting HIFs may be an effective early treatment for diabetic retinopathy. However, while the HIF inhibitor acriflavine prevented retinal vascular hyperpermeability in diabetic mice for several months following a single intraocular injection, accumulation of acriflavine in the retina resulted in retinal toxicity over time, raising concerns for its use in patients. Conversely, 32-134D, a recently developed HIF inhibitor structurally unrelated to acriflavine, was not toxic to the retina, yet effectively inhibited HIF accumulation and normalized HIF-regulated gene expression in mice and in human retinal organoids. Intraocular administration of 32-134D prevented retinal neovascularization and vascular hyperpermeability in mice. These results provide the foundation for clinical studies assessing 32-134D for the treatment of patients with diabetic eye disease.
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Affiliation(s)
- Jing Zhang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Deepti Sharma
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aumreetam Dinabandhu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology and Diagnostic Sciences, School of Dentistry, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland, USA
| | - Jaron Sanchez
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brooks Applewhite
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Jee
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Monika Deshpande
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miguel Flores-Bellver
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ming-Wen Hu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chuanyu Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shaima Salman
- Armstrong Oxygen Biology Research Center; Vascular Program, Institute for Cell Engineering; Departments of Pediatrics, Medicine, Oncology, Radiation Oncology, Biological Chemistry, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yousang Hwang
- Armstrong Oxygen Biology Research Center; Vascular Program, Institute for Cell Engineering; Departments of Pediatrics, Medicine, Oncology, Radiation Oncology, Biological Chemistry, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole M. Anders
- The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology and the Division of Clinical Pharmacology at the School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle A. Rudek
- The Sidney Kimmel Comprehensive Cancer Center, Department of Oncology and the Division of Clinical Pharmacology at the School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiang Qian
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M. Valeria Canto-Soler
- CellSight Ocular Stem Cell and Regeneration Research Program, Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gregg L. Semenza
- Armstrong Oxygen Biology Research Center; Vascular Program, Institute for Cell Engineering; Departments of Pediatrics, Medicine, Oncology, Radiation Oncology, Biological Chemistry, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Silvia Montaner
- Department of Oncology and Diagnostic Sciences, School of Dentistry, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland, USA
| | - Akrit Sodhi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abdelmassih Y, El Khoury S, Dureau P, Edelson C, Metge F, Caputo G. Surgical removal of submacular choroidal neovessels in children: Outcome and literature review. Eur J Ophthalmol 2023; 33:514-523. [PMID: 35816395 DOI: 10.1177/11206721221112537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To report on the outcome of surgical submacular choroidal neovascular membrane (CNV) removal in children and to perform a comprehensive review of literature concerning this intervention in children. METHODS In this retrospective, noncomparative, interventional case series, we included 8 eyes of 7 consecutive children with subfoveal choroidal neovascularization treated by pars plana vitrectomy (PPV) and CNV removal. Main outcome measures were visual acuity and complications. RESULTS Mean age at surgery was 8.6 ± 5.2 years (range: 2-16). Two out of 8 eyes were idiopathic. Corrected-distance visual acuity (CDVA) improved from 1.01 ± 0.45logMAR (range:0.3-1.5) at presentation to 0.60 ± 0.37 (range:0-1) at last follow-up (p = 0.03). Mean follow-up was 3.9 ± 3.9 years. Six eyes received at least one intravitreal injection of bevacizumab prior to surgery. Recurrence occurred in one eye with Best's disease.Literature review revealed a total of 42 cases with the most frequent etiologies being Presumed ocular histoplasmosis syndrome (POHS) and idiopathic CNV. Considering all cases together, mean CDVA improved from 1.00 ± 0.37logMAR to 0.52 ± 0.42 (p < 0.01). CNV recurrence occurred in 11 eyes (22.0%), 7 of which had an inflammatory etiology. Other complications included pigment epithelium tear, atrophy and retinal tear. CONCLUSION Surgical removal of CNV is a viable, effective and safe option in children with persistent submacular neovascular membranes.
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Affiliation(s)
- Youssef Abdelmassih
- Pediatric Ophthalmology Department, 55659Fondation Ophtalmologique Rothschild, Paris, France
| | - Sylvain El Khoury
- Pediatric Ophthalmology Department, 55659Fondation Ophtalmologique Rothschild, Paris, France
| | - Pascal Dureau
- Pediatric Ophthalmology Department, 55659Fondation Ophtalmologique Rothschild, Paris, France
| | - Catherine Edelson
- Pediatric Ophthalmology Department, 55659Fondation Ophtalmologique Rothschild, Paris, France
| | - Florence Metge
- Pediatric Ophthalmology Department, 55659Fondation Ophtalmologique Rothschild, Paris, France
| | - Georges Caputo
- Pediatric Ophthalmology Department, 55659Fondation Ophtalmologique Rothschild, Paris, France
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Shute CL, McLoone E. Reaching a FEVR Pitch: A Case Series of Familial Exudative Vitreoretinopathy in Northern Ireland. J Pediatr Ophthalmol Strabismus 2022; 59:102-109. [PMID: 34592872 DOI: 10.3928/01913913-20210720-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the heterogeneity of both the clinical features and genetics of familial exudative vitreoretinopathy (FEVR) in a Northern Irish population. METHODS A retrospective trawl of a secure pediatric database was completed, as well as communication with all Northern Ireland ophthalmologists to identify adult cases. Cases were cross-referenced with a regional genetics database. Data on patient demographics, clinical findings, genetic testing, and patient treatment were collected. RESULTS Sixteen patients were identified. Average age at presentation was 11.8 years (range: 4 months to 38 years). Earlier age at presentation was associated with more advanced disease and those presenting later had more subtle signs such as retinal tear or vitreous hemorrhage. Four types of gene mutations were identified in 7 patients (NDP, TSPAN12, FZD4, and KIF11). Thirteen patients had complications associated with FEVR and associated systemic conditions were found in 5 patients. Twelve eyes received active treatment to control disease. CONCLUSIONS FEVR is a sight-threatening disease affecting prenatal retinal angiogenesis with a spectrum of disease and diverse genetic basis. Clinicians should look for signs of systemic and other ophthalmic sequelae in patients with FEVR because this could point to a genetic cause. Vigilance should also be exercised in older patients with unexplained vitreous hemorrhage or retinal tear with consideration of widefield angiography if FEVR is suspected. [J Pediatr Ophthalmol Strabismus. 2022;59(2):102-109.].
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Ranjan R, Salian R, Verghese S, Manayath GJ, D'Souza P, Kanakath AV, Shah PK, Saravanan VR, Venkatapathy N. Pediatric choroidal neovascularization: Etiology and treatment outcomes with anti-vascular endothelial growth factors. Eur J Ophthalmol 2021; 32:2355-2367. [PMID: 34615395 DOI: 10.1177/11206721211048799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the etiology and treatment outcomes of choroidal neovascularization (CNV) in a pediatric population with intravitreal anti-vascular endothelial growth factors (VEGF). METHODS Retrospective single center interventional case series. A total of 26 eyes of 23 consecutive pediatric patients with CNV of various etiologies were treated with intravitreal injection of anti-VEGF agents. RESULTS There were 15 males (65.2%) and eight females (34.8%), diagnosed with CNV during the study period. The mean age at presentation with CNV was 11.7 ± 3.3 years, (range 4-16 years) and the mean follow was 28.1 ± 18 months, (range 8-72 months). Inflammatory CNV was the most common etiology. The mean best corrected visual acuity (BCVA) and mean central macular thickness (CMT) at presentation, were logMAR 0.8 ± 0.3 and 367.6 ± 134.8 µm respectively. At the final visit, CNV in all eyes remained regressed with significant improvement in mean BCVA to logMAR 0.4 ± 0.4 (p < 0.0001) and mean CMT to 242.5 ± 82.4 µm (p < 0.0001). A mean of two intravitreal injections per eye was required for CNV regression. CONCLUSION Intravitreal anti-VEGF therapy for pediatric CNV is an effective treatment in majority of affected eyes.
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Affiliation(s)
- Ratnesh Ranjan
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - Romit Salian
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - Shishir Verghese
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - George J Manayath
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | - Palmeera D'Souza
- Department of Retina and Vitreous services, Aravind Eye Hospital, Coimbatore, India
| | | | - Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
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Lyu J, Zhang Q, Xu Y, Zhang X, Fei P, Zhao P. INTRAVITREAL RANIBIZUMAB TREATMENT FOR ADVANCED FAMILIAL EXUDATIVE VITREORETINOPATHY WITH HIGH VASCULAR ACTIVITY. Retina 2021; 41:1976-1985. [PMID: 34432746 PMCID: PMC8384247 DOI: 10.1097/iae.0000000000003122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the efficacy of intravitreal ranibizumab (IVR) treatment for advanced familial exudative vitreoretinopathy with high vascular activity. METHODS The retrospective interventional case series included 28 eyes (20 patients) that had IVR in combination or not with other treatment, for Stage 3 to 5 familial exudative vitreoretinopathy with active fibrovascular proliferation and prominent subretinal exudation. Outcome measures were fundus features after treatment, associated clinical variables, and genetic mutations. RESULTS The age of patients at the first IVR ranged from 0.2 to 36 months. An average of 1.3 IVR injections per eye were given. Familial exudative vitreoretinopathy regressed in 16 (57%) eyes and progressed in 12 eyes (43%) after IVR. Laser and/or vitrectomy was performed on 13 eyes. The retina was reattached in 22 eyes (78%) after 24 to 58 months follow-up. Clinical variables associated with progression after IVR were preexisting fibrovascular proliferation over one quadrant and persistent vascular activity after the initial injection (P < 0.05). Familial exudative vitreoretinopathy-causative genetic mutations in 11 patients were related to variable response to IVR treatment. CONCLUSION Intravitreal ranibizumab treatment may effectively regress advanced familial exudative vitreoretinopathy with high vascular activity in selected cases. Different treatment outcomes may be relevant to variable presentation and genetic heterogeneity of familial exudative vitreoretinopathy.
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Affiliation(s)
- Jiao Lyu
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Zhang
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Zhang
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Fei
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Analysis of Predisposing Clinical Features for Worsening Traction After Treatment of Familial Exudative Vitreoretinopathy in Children. Am J Ophthalmol 2021; 223:430-445. [PMID: 32707203 DOI: 10.1016/j.ajo.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the incidence of worsening vitreoretinal traction after laser treatment for familial exudative vitreoretinopathy (FEVR) and to determine whether any baseline clinical features are associated with worsening. DESIGN Retrospective cohort comparison study in a university tertiary referral center. METHODS All patients 0-21 years of age treated with laser from January 1, 2001, to June 1, 2018, were studied. Worsening traction after treatment was defined as the occurrence within 6 months of worsening or development of tractional retinal detachment, folds, dragging, breaks, rhegmatogenous detachment, or worsening tractional membranes. Comparisons of baseline features between groups with and without worsening were performed to determine features associated with higher risk. RESULTS A total of 46 eyes from 28 patients met inclusion criteria. Of the 46 eyes, 6 (13%) had worsening after treatment. There were no significant differences in age or other baseline demographics between the cohorts with and those without worsening traction. The presence of proliferative tissue in contact with the lens was found in 2 of 6 patients with worsening compared to 1 of 40 (3%) without worsening (P = .04). Mean follow-up was 57.8 months (range, 6.6-134 months). At the 6-month follow-up, median logMAR visual acuity in the cohorts with and without worsening was 1.7 (Snellen 20/1002; n = 5) and 0.24 (Snellen 20/35; n = 16), respectively. CONCLUSIONS Laser treatment resulted in worsening traction in a substantial proportion of eyes with FEVR. Children with proliferative tissue in contact with the lens may be at higher risk of worsening after laser. Potential measures to reduce risk will require further study to establish efficacy.
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Carroll RM, Kim BJ. Asymptomatic adults in a single family with familial exudative vitreoretinopathy and TSPAN12 variant. Ophthalmic Genet 2020; 40:474-479. [PMID: 31755339 DOI: 10.1080/13816810.2019.1686157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Familial exudative vitreoretinopathy (FEVR) is a disorder of retinal angiogenesis associated with mutations in multiple genes related to the Wnt pathway. The disease is characterized by a spectrum of ophthalmic manifestations that range from asymptomatic to blinding. While FEVR has classically been considered a diagnosis made in the pediatric population, it can be seen in adults and lead to vision loss if unidentified. We present three asymptomatic adults in a single, five-member family with clinical findings and genetic testing supportive of a diagnosis of FEVR.Materials and Methods: Case series. All patients underwent ophthalmologic examination, diagnostic imaging, and genetic testing.Results: A 32-year-old female was referred for evaluation of abnormal retinal vessels. Clinical examination and diagnostic testing revealed retinal vascular dragging, peripheral avascularity, and retinal neovascularization suggestive of a diagnosis of FEVR. Genetic testing was positive for a heterozygous intronic variant (c.149 + 3A>G) in TSPAN12. The same variant was identified in the patient's mother and one adult sister, each showing evidence of early stage FEVR. The patient's father and second adult sister had normal eye exams with negative genetic testing. All patients were asymptomatic with good vision.Conclusions: FEVR can be first diagnosed in asymptomatic adult patients who may require treatment. The disease, therefore, may be incompletely characterized and under diagnosed. The specific variant in TSPAN12 identified in this family may be associated with early stage FEVR or disease that manifests later in life. Clinical correlation with exact variants such as this may enhance our understanding of this disease.
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Affiliation(s)
- Robert M Carroll
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin J Kim
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Belin PJ, Lee AC, Greaves G, Kosoy J, Lieberman RM. The use of bevacizumab in pediatric retinal and choroidal disease: A review. Eur J Ophthalmol 2019; 29:338-347. [PMID: 30757919 DOI: 10.1177/1120672119827773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of intravitreal bevacizumab in pediatric retinal and uveitic disease has become more widespread over the past decade. This article serves to outline the rationale underlying the use of intravitreal bevacizumab, and which disease entities it should be appropriately thought of as a primary or solo therapy, as opposed to an adjuvant one. Also presented is the relevant literature regarding each of these retinopathies.
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Affiliation(s)
- Peter J Belin
- 1 Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Andrew C Lee
- 1 Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Giovanni Greaves
- 1 Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Jennifer Kosoy
- 2 Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Ronni M Lieberman
- 3 Department of Ophthalmology, Icahn School of Medicine, Mount Sinai Medical Center and New York City Health and Hospitals, New York, NY, USA
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Gan WL, Long VW. Paediatric case of peripapillary choroidal neovascularisation associated with optic disc drusen treated with aflibercept. BMJ Case Rep 2019; 12:12/1/bcr-2018-228134. [PMID: 30642868 DOI: 10.1136/bcr-2018-228134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Peripapillary choroidal neovascularisation (PPCNV) associated with optic disc drusen is a rare complication that can result in severe vision impairment in children. We report the first case of paediatric PPCNV secondary to optic disc drusen successfully treated with intravitreal aflibercept. A 6-year-old girl presented with a one week history of reduced vision in her right eye with best-corrected visual acuity of 20/500. Fundus examination revealed bilateral elevated discs with a peripapillary pigmentary lesion in the right eye. Optical coherence tomography of the right eye showed marked subfoveal fluid. Both B-scan ultrasonography and fundus autofluorescence demonstrated findings consistent with optic disc drusen. Diagnosis of PPCNV was further confirmed on fluorescein fundus angiography. The child received three intravitreal aflibercept injections with complete resolution of the subfoveal fluid. Her visual acuity improved to 20/25 with no recurrence at a 16-month follow-up. No adverse side effects were reported.
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Affiliation(s)
- Weh Loong Gan
- The University of Leeds, Leeds, UK.,Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vernon W Long
- The University of Leeds, Leeds, UK.,Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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12
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Lu YZ, Deng GD, Liu JH, Yan H. The role of intravitreal ranubizumab in the treatment of familial exudative vitreoretinopathy of stage 2 or greater. Int J Ophthalmol 2018; 11:976-980. [PMID: 29977810 DOI: 10.18240/ijo.2018.06.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/07/2018] [Indexed: 01/25/2023] Open
Abstract
AIM To evaluate the role of intravitreal ranubizumab (IVR) in the treatment of familial exudative vitreoretinopathy (FEVR) of stage 2 or greater either as primary or an ajunct to conventional treatments. METHODS Retrospective, non-controlled clinical study. Thirty patients (37 eyes) diagnosed with FEVR were enrolled. Twenty patients (66.67%) were male and 10 patients (33.33%) were female. Age ranged from 0.4 to 35 years old (median 3y). IVR was used either as primary or as a combined therapy according to the retinal neovasuclar activities. The follow up ranged from 1 to 57mo with mean 16.73±15.73 (median 11)mo. The treatment effect of retinal neovasuclar activites were recorded as well as the ocular and systemic side effects. RESULTS Among 30 patients (37 eyes), 10 eyes received single IVR, 1 eye received 2 injections. Three eyes were treated with IVR and simutanous laser photocoagulation. Laser indirect ophthalmoscopy (LIO) was applied in 5 eyes 1mo after the primary IVR. Seven eyes were treated surgically following the primary IVR due to persistent retinal neovasuclar activities and retinal traction. IVR was used as combined treatment with vitrectomy in 11 eyes. Retinal neovascular regression was notified 1mo following the primary IVR in all eyes. Neither systemic nor ocular complications were recorded. CONCLUSION IVR may be an effective modality in the treatment of FEVR either as primary or as an ajunct to the conventional therapies. The long term effect and safty of IVR still need further research.
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Affiliation(s)
- Yue-Zhu Lu
- The First Clinical College of Chongqing Medical University, Chongqing 400016, China
| | - Guang-Da Deng
- Department of Opthalmology, Beijing Tongren Hospital, Capital University of Medical Sience, Beijing 100730, China
| | - Jing-Hua Liu
- Department of Opthalmology, Beijing Tongren Hospital, Capital University of Medical Sience, Beijing 100730, China
| | - Hong Yan
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Moosajee M, Abbouda A, Foot B, Bunce C, Moore AT, Acheson J. Active surveillance of choroidal neovascularisation in children: incidence, aetiology and management findings from a national study in the UK. Br J Ophthalmol 2017; 102:438-443. [DOI: 10.1136/bjophthalmol-2017-310445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 11/03/2022]
Abstract
Background/AimsTo determine the UK incidence, demographics, aetiology, management and visual outcome for children developing choroidal neovascularisation (CNV).MethodsA prospective population-based observational study of routine practice via the British Ophthalmological Surveillance Unit between January 2012 and December 2013 with subsequent 1-year follow-up in children under 16 years old with newly diagnosed CNV.ResultsTwenty-seven children with CNV were reported. The UK estimated annual incidence for those aged 16 and under was 0.21 per 100 000 (95% CI 0.133 to 0.299). The mean age was 11.1 years (SD 3.9, range 4–16). Fourteen were female. Seventy-seven per cent (22 patients) were Caucasian British. Twenty-three children (85%) had unilateral disease. The most common aetiology included inflammatory retinochoroidopathy (n=9), optic disc abnormalities (n=9) and idiopathic (n=5). Optical coherence tomography was performed in all cases and fundus fluorescein angiography in 61%. Management included observation only (n=10), anti-vascular endothelial growth factor (anti-VEGF) injection of bevacizumab (n=14) or ranibizumab (n=2), or both (n=1), and additional use of oral (n=1) and local (periocular n=2 and intravitreal n=2) steroids in five children with inflammatory retinochoroidopathy. The mean number of anti-VEGF injections was 2±1, with eight patients receiving only one injection. The mean (SD) best corrected visual acuity in LogMAR was 0.91 (0.53) at presentation and 0.74 (0.53) at 1-year follow-up (p=0.09).ConclusionThis is the first population-based prospective study of CNV in children. This is a rare disorder with a poor visual prognosis irrespective of CNV location and the use of anti-VEGF therapy.
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Read SA, Alonso-Caneiro D, Vincent SJ. Longitudinal changes in macular retinal layer thickness in pediatric populations: Myopic vs non-myopic eyes. PLoS One 2017; 12:e0180462. [PMID: 28662138 PMCID: PMC5491256 DOI: 10.1371/journal.pone.0180462] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/15/2017] [Indexed: 12/14/2022] Open
Abstract
Knowledge of the normal in vivo thickness of the retina, and its individual layers in pediatric populations is important for diagnosing and monitoring retinal disorders, and for understanding the eye’s normal development and the impact of eye growth and refractive error such as myopia (short-sightedness) upon retinal morphology. In this prospective, observational longitudinal study, total retinal thickness (and individual retinal layer thickness) and the changes in retinal morphology occurring over an 18-month period were examined in 101 children with a range of refractive errors. In childhood, the presence of myopia was associated with subtle but statistically significant (p<0.05) changes in the topographical thickness distribution of macular retinal thickness (and retinal layer thickness), characterised by a thinning of the parafoveal retina (and parafoveal or perifoveal thinning in most outer and inner retinal layers). The parafoveal retina was on average 6 μm thinner in myopic children. However, over 18 months, longitudinal changes in retinal thickness and individual layers were of small magnitude (average changes of less than 2 μm over 18 months), indicative of a high degree of stability in retinal morphology in healthy adolescent eyes, despite significant eye growth over this same period of time. This provides the first detailed longitudinal assessment of macula retinal layer morphology in adolescence, and delivers new normative data on expected changes in retinal structure over time and associated with myopia during this period of childhood development.
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Affiliation(s)
- Scott A. Read
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen J. Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Diagnostic and Therapeutic Challenges. Retina 2017; 37:1805-1808. [PMID: 28134739 DOI: 10.1097/iae.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pediatric choroidal neovascularization: should we be more afraid of Virginia Woolf or of the big bad wolf? Eur J Ophthalmol 2016; 26:385-7. [PMID: 27405289 DOI: 10.5301/ejo.5000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
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