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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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Roy D, Chatterjee A, Mishra L, Chakraborty N. Progression of retinal choroidal neovascularization by latent human cytomegalovirus infection and immunological signaling among neonatal patients admitted to tertiary care hospital. J Med Virol 2024; 96:e29478. [PMID: 38377063 DOI: 10.1002/jmv.29478] [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: 12/29/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
Choroidal neovascularization (CNV) is a serious condition that affects the retina, causing partial or complete blindness in people of different ages. While CNV is a common occurrence in various chorioretinopathies, research on its occurrence in neonates is limited. Human cytomegalovirus (HCMV) is a significant health threat to neonates, with a strong association with retinal angiogenesis. However, there has been limited investigation into HCMV-associated CNV progression. In this article, we extensively studied the expression of different inflammatory cytokines and chemokines during latent HCMV-associated retinal neovascularization. Our research found that HCMV-induced CNV progression was significantly prominent in the presence of AT2R-dependent angiogenesis (p < 0.001), whereas in the absence of HCMV, AT1R-dependent CCL-5-mediated angiogenesis was documented. We also observed significant increases in CCL-19, CCL-21 chemokine responses, followed by CCR-7 chemokine receptor activation (p < 0.001) in HCMV-induced CNV patients compared to HCMV non-induced CNV groups. Furthermore, significant changes in predictive chemokine markers of HCMV-induced CNV were positively correlated with HCMV viremia. These immunological alterations ultimately lead to the switching of NFκB canonical and noncanonical pathways, respectively, in HCMV-induced neonatal CNV and HCMV non-induced CNV. This clinical observation presents a novel hypothesis that ocular HCMV latency poses a noteworthy risk factor for the progression of retinal neovascularization through a distinctive immunological signaling pathway. The current study represents the first of its kind to report on this association, which may have significant implications for the clinical management of patients with ocular HCMV.
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Affiliation(s)
- Debsopan Roy
- Virus Research Laboratory, ICMR-NICED, Kolkata, West Bengal, India
| | - Aroni Chatterjee
- Department of Biotechnology, School of Biotechnology and Bioscience, Brainware University, Kolkata, West Bengal, India
| | - Lopamudra Mishra
- Department of Pediatrics, IPGME&R, SSKM Hospital, Kolkata, West Bengal, India
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Cennamo G, Massa L, Montanaro L, Magli A, Costagliola C. Reply to comment on: Morphovascular changes after Anti-VEGF intravitreal injection for a choroidal neovascularization secondary to COVID-19 infection in a pediatric patient. Photodiagnosis Photodyn Ther 2023; 43:103675. [PMID: 37369260 PMCID: PMC10290762 DOI: 10.1016/j.pdpdt.2023.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Gilda Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy.
| | - Luigi Massa
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Lucia Montanaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Adriano Magli
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
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Abi Karam M, Guillaum-Czitrom S, Melki I, Dumaine C, Gargouri MA, Fares S, Cochereau I, Titah C. Role of anti-TNF in Pediatric Inflammatory Choroidal Neovascularization: A Case Series. Ocul Immunol Inflamm 2022:1-7. [PMID: 35675035 DOI: 10.1080/09273948.2022.2081583] [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: 10/18/2022]
Abstract
OBJECTIVE To highlight the safety and efficacy of Tumor Necrosis Factor inhibitors (anti-TNF) in inflammatory choroidal neovascularization (CNV) in the pediatric population. DESIGN Retrospective case series. PARTICIPANTS Three patients, < 16 years old with uveitic inflammatory CNV. METHODS Patients received systemic steroids, methotrexate (MTX), intravitreal (IVT) injections of bevacizumab, and anti-TNF (infliximab or adalimumab) in case of refractory leakage. RESULTS Five eyes of three pediatric patients (mean age 6 years old) presenting with CNV and put on anti-TNF were followed up for a minimum of 32 months. Four out of five eyes had improved vision, reduced fluid on clinical exam and macular spectral-domain optical coherence tomography (SD-OCT), and cessation of leakage on fundus fluorescein angiography (FFA) after introduction of anti-TNF agents. Two patients developed minor psoriasis treated topically. CONCLUSION Anti-TNF agents showed efficacy and safety in a sustainable leakage control of inflammatory pediatric CNV along with improvement in vision.
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Affiliation(s)
- Mariana Abi Karam
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | | | - Isabelle Melki
- Robert Debré Hospital, Department of Pediatric, AP-HP, Paris, France
| | - Cecile Dumaine
- Robert Debré Hospital, Department of Pediatric, AP-HP, Paris, France
| | | | - Selim Fares
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | - Isabelle Cochereau
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | - Cherif Titah
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
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Zhang T, Wang Y, Yan W, Liu Y, Lu J, Sun L, Li S, Huang L, Zhang Z, Ding X. Choroidal Neovascularization in Pediatric Patients: Analysis of Etiologic Factors, Clinical Characteristics and Treatment Outcomes. Front Med (Lausanne) 2021; 8:735805. [PMID: 34912817 PMCID: PMC8666601 DOI: 10.3389/fmed.2021.735805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Choroidal neovascularization (CNV) is a common pathologic lesion that occurs in various chorioretinopathy, but very limited published data have reported in pediatric patients. This study aimed to investigate the etiologic factors, clinical features, and treatment outcomes of choroidal neovascularization (CNV) in children. Methods: In this study, 33 eyes in 30 patients aged 18 years or younger with CNV were included. Comprehensive ophthalmic examination was performed in all the patients. The demographic profiles, laterality, visual acuity, optical coherence tomographic findings, fundus fluorescein angiographic findings, and the underlying pathology were analyzed. The types, locations, treatment outcomes, and recurrences of CNV were noted. Results: The average age was 11.2 ± 4.6 (range, 1–18) years. Most CNVs affecting children were classic and type 2. The most common etiologic factors of CNV in pediatric patients were congenital/developing abnormalities (9/30, 30.0%) and inflammatory retinochoroidopathy (9/30, 30.0%), followed by idiopathic CNV (8/30, 26.7%). Subtype analysis showed that the etiologic factor was inflammatory retinochoroidopathy in children 12 years or older, whereas congenital/developing abnormalities were present in children younger than 12 years. Eyes with active CNVs required a mean of 1.40 ± 0.58 injections. No recurrence was observed during follow-up. Conclusions: The etiologic factors of CNV in young Chinese patients were diverse, with congenital/developing abnormalities, inflammatory retinochoroidopathy and idiopathic CNV being the 3 most common ones. Eyes with active CNVs had good responses to antivascular endothelial growth factor treatment with low recurrence.
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Affiliation(s)
- Ting Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - You Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenjia Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yafen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jinglin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Etiology, Treatment Patterns, and Outcomes for Choroidal Neovascularization in the Pediatric Population: An Intelligent Research in Sight (IRIS®) Registry Study. Ophthalmol Retina 2021; 6:130-138. [PMID: 34091079 DOI: 10.1016/j.oret.2021.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Choroidal neovascularization (CNV) is a rare, but devastating, cause of vision loss in children, with most current publications limited to small case series. Using a large clinical registry allowed us to understand the most common causes of this disease and the visual outcomes. DESIGN Retrospective analysis. PARTICIPANTS Patients younger than 18 years in the Intelligent Research in Sight Registry diagnosed with CNV between 2013 and 2019. METHODS Cases were identified based on International Classification of Diseases, Ninth and Tenth Revisions, diagnosis codes for CNV or CNV-related etiology and Current Procedural Terminology treatment codes. MAIN OUTCOME MEASURES Etiology of CNV, treatment patterns, and visual outcomes. RESULTS Two thousand three hundred fifty-three eyes with pediatric CNV were identified. The most common identifiable causes of pediatric CNV were posterior uveitis or inflammatory chorioretinal disease (19.4%), myopia (18.4%), hereditary dystrophy (5.4%), chorioretinal scar (4.2%), choroidal rupture (3.5%), optic nerve drusen (3.2%), osteoma (1.9%), and solar retinopathy (0.2%). In 38.2% of eyes, CNV was idiopathic, and in 5.7% of eyes, multiple causes were coded. One thousand forty-one eyes (44.4%) underwent treatment. The mean age of mean age of patients whose eyes received treatment 13.6 ± 3.5 years compared with 12.4 ± 4.1 years for the untreated group (P < 0.001). In 88.9% of eyes, anti-vascular endothelial growth factor (VEGF) injections were administered, 7.9% of eyes received laser therapy, 0.3% of eyes received photodynamic therapy, and 2.9% of eyes received combination therapy. In the eyes receiving anti-VEGF agents, 68.4% required 3 injections or fewer (P < 0.0001). Eyes undergoing treatment exhibited worse baseline visual acuity (VA) than eyes that did not undergo treatment (0.62 ± 0.50 logarithm of the minimum angle of resolution [logMAR] vs. 0.44 ± 0.50 logMAR; P < 0.0001). Visual acuity in the treatment group improved significantly from 0.62 ± 0.50 logMAR at baseline to 0.39 ± 0.43 logMAR at year 1 (P < 0.0001). Visual acuity in the untreated group improved significantly from 0.44 ± 0.50 logMAR at baseline to 0.34 ± 0.44 logMAR at year 1 (P < 0.001). Treated eyes showed a statistically significant higher odds of exhibiting a 2-line vision improvement or better compared with the untreated group at 12 months regardless of treatment type and after controlling for baseline VA (odds ratio, 2.4; P < 0.0001). CONCLUSIONS CNV is a rare, sight-threatening condition in children, with the most common causes being idiopathic, inflammatory chorioretinal disease, and myopia. Eyes undergoing treatment tended to be in older patients and showed worse baseline VA compared with eyes that did not undergo treatment. Those that were treated experienced significant improvement in vision that was maintained in the long term.
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Kitano M, Tanaka R, Kaburaki T, Nakahara H, Shirahama S, Suzuki T, Komae K, Aihara M. Clinical Features and Visual Outcome of Uveitis in Japanese Patients Younger than 18 Years. Ocul Immunol Inflamm 2020; 29:1280-1286. [DOI: 10.1080/09273948.2020.1726972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Marie Kitano
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Medical Center, Itabashi-Ku, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Ophthalmology, Jichi Ika University Saitama Medical Center, Omiya, Saitama, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Shintaro Shirahama
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takafumi Suzuki
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Keiko Komae
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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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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