Optical coherence tomography in the diagnosis of choroidal neovascularization in children

Cover Page
Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract


AIM: Report cases of choroidal neovascularization (CNV) in children and describe structural and hemodynamic changes in retina associated with this pathology detected by Optical Coherence Tomography (OCT) and OCT-angiography (OCTA).

MATERIALS AND METHODS: 6 children (4 girls, 2 boys) aged from 7 to 17 years with CNV associated with pathological myopia, post-traumatic choroid rupture and optic disc abnormalities were examined. The activity of neovascular complexes was evaluated by ophthalmoscopy, OCT, and OCTA. The maximum follow-up period was 4 years.

RESULTS: 7 cases of CNV were detected. One child had a two-way process. Myopic and posttraumatic membranes were localized sub- and juxtafoveally and were the membranes of type 2. In children with optic disc anomalies of the 1 type membrane and mixed (1st and 2nd) type was located extrafoveally. The decrease in visual acuity was determined by the localization of membranes, the severity of edema, and the severity of dystrophic changes in the retina. On OCT, subretinal fluid and hyperreflective material corresponding to hemorrhages were visualized in the projection of active membranes. OCTA revealed a network of small capillaries with a large number of loops and anastomoses. Intravitreal angiogenesis inhibitors injections were performed in 5 cases. A persistent effect after a single injection was observed in 2 cases. The return of membrane activity in 3 cases allowed us to justify the repeated administration of angiogenesis inhibitors. Along with a decrease in the activity of CNV, progressive dystrophic changes in the pigment epithelium around the membrane were detected.

CONCLUSIONS: High sensitivity of OCT was demonstrated for early detection of structural and hemodynamic retinal disorders, determining the activity of neovascular complexes, predicting outcomes of the disease, and evaluating the effectiveness of therapeutic measures. The progression of dystrophic changes in the retinal pigment epithelium in response to therapy with angiogenesis inhibitors requires long-term monitoring of children and determining the optimal strategy for treating CNV in children.


Full Text

Restricted Access

About the authors

Svetlana I. Zhukova

S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

Author for correspondence.
Email: zhukswetlana@yandex.ru
ORCID iD: 0000-0002-0227-7682

Russian Federation, 337 Lermontova str., Irkutsk, 664033

PhD, ophthalmologist

Dmitry Yu. Samsonov

S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

Email: dsamsonoff@mail.ru
ORCID iD: 0000-0001-7971-4521

Russian Federation, 337 Lermontova str., Irkutsk, 664033

PhD, ophthalmologist

Igor V. Zlobin

S.N. Fedorov National Medical Research Center “MNTK “Eye Microsurgery”

Email: zlobig@mail.ru
ORCID iD: 0000-0002-0884-5513

Russian Federation, 337 Lermontova str., Irkutsk, 664033

PhD, ophthalmologist

References

  1. Bressler NM. Age-related macular degeneration is the leading cause of blindness. JAMA. 2004;291(15):1900–1901. doi: 10.1001/jama.291.15.1900
  2. Friedman DS, O’Colmain BJ, Munoz B, et al. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004;122(4):564–572. doi: 10.1001/archopht.122.4.564
  3. Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82(11):844–851.
  4. Bird AC, Bressler NM, Bressler SB, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol. 1995;39(5):367–374. doi: 10.1016/s0039-6257(05)80092-x
  5. Li YH, Cheng CK, Tseng YT. Clinical characteristics and antivascular endothelial growth factor effect of choroidal neovascularization in younger patients in Taiwan. Taiwan J Ophthalmol. 2015;5(2): 76–84. doi: 10.1016/j.tjo.2015.03.001
  6. Miller DG, Singerman LJ. Vision loss in younger patients: a review of choroidal neovascularization. Optom Vis Sci. 2006;83(5): 316–325. doi: 10.1097/01.opx.0000216019.88256.eb
  7. Spaide RF. Choroidal neovascularization in younger patients. Curr Opin Ophthalmol. 1999;10(3):177–181. doi: 10.1097/00055735-199906000-00005
  8. Cohen SY, Laroche A, Leguen Y, et al. Etiology of choroidal neovascularization in young patients. Ophthalmology. 1996;103(8): 1241–1244. doi: 10.1016/s0161-6420(96)30515-0
  9. Sears J, Capone A Jr, Aaberg TSr, et al. Surgical management of subfoveal neovascularization in children. Ophthalmology. 1999;106(5):920–924. doi: 10.1016/S0161-6420(99)00510-2
  10. Rich R, Vanderveldt S, Berrocalet AM. Treatment of Choroidal Neovascularization Associated with Best’s Disease in Children. J Pediatr Ophthalmol Strabismus. 2009;46(5):306–311. doi: 10.3928/01913913-20090903-10
  11. Grewal DS, Tran-Viet D, Vajzovic L, et al. Association of pediatric choroidal neovascular membranesat the temporal edge of optic nerve and retinochoroidal coloboma. Am J Ophthalmol. 2017;174:104–112. doi: 10.1016/j.ajo.2016.10.010
  12. Rotruck J. A Review of Optic Disc Drusen in Children. Int Ophthalmol Clin. 2018;58(4):67–82. doi: 10.1097/iio.0000000000000236
  13. Aver’yanov DA, Alpatov SA, Zhukova SI, et al. Optical coherence tomography in the diagnosis of eye diseases. Shhuko AG, Malysheva VV, eds. Moscow: GEOTAR-Media; 2010. 126 p. (In Russ.)
  14. Ong SS, Hsu ST, Grewal D, et al. Appearance of pediatric choroidal neovascular membranes on optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol. 2020;258(1):89–98. doi: 10.1007/s00417-019-04535-4
  15. Veronese C, Maiolo C, Huang D, et al. Optical coherence tomography angiography in pediatric choroidal neovascularization. Am J Ophthalmol Case Rep. 2016;2:37–40. doi: 10.1016/j.ajoc.2016.03.009
  16. House RJ, Hsu ST, Thomas AS, et al. Vascular findings in a small retinoblastoma tumor using OCT angiography. Ophthal Retina. 2019;3(2):194–195. doi: 10.1016/j.oret.2018.09.018
  17. Hsu ST, Chen X, House RJ, et al. Visualizing macular microvasculature anomalies in 2 infants withtreated retinopathy of prematurity. JAMA Ophthalmol. 2018;136(12):1422–1424. doi: 10.1001/jamaophthalmol.2018.3926
  18. Hsu ST, Chen X, Ngo HT, et al. Imaging infant retinal vasculature with OCT angiography. Ophthalmol Retina. 2018;3(1):95–96. doi: 10.1016/j.oret.2018.06.017
  19. Hsu ST, Finn AP, Chen X, et al. Macular microvascular findings in familial exudative vitreoretinopathy on optical coherence tomography angiography. Ophthalmic Surg Lasers Imaging Retina. 2019;50(5):322–329. doi: 10.3928/23258160-20190503-11
  20. Wong YL, Saw SM. Epidemiology of pathologic myopia in Asia and worldwide. Asia Pac J Ophthalmol. 2016;5(6):394–402. doi: 10.1097/APO.0000000000000234
  21. Gao LQ, Liu W, Liang YB, et al. Prevalence and characteristics of myopic retinopathy in a rural Chinese adult population: The Handan Eye Study. Arch Ophthalmol. 2011;129(9):1199–204. doi: 10.1001/archophthalmol.2011.230
  22. Ohno-Matsui K, Jonas JB, Spaide RF. Macular Bruch membrane holes in choroidal neovascularization-related myopic macular atrophy by swept-source optical coherence tomography. Am J Ophthalmol. 2016;162:133–139.e1. doi: 10.1016/j.ajo.2015. 11.014
  23. Traboulsi EI, Jurdi-Nuwayhid F, Torbey NS, et al. Aniridia, atypical iris defects, optic pit and the morning glory disc anomaly in a family. Ophthalmic Paediatr Genet. 1986;7(2):131–135. doi: 10.3109/13816818609076122
  24. Safari A, Jafari E, Borhani-Haghighi A. Morning glory syndrome associated with multiple sclerosis. Iran J Neurol. 2014;13(3): 177–180.
  25. Steinkuller PG. The morning glory disk anomaly: Case report and literature review. J Pediatr Ophthalmol Strabismus. 1980;17(2): 81–87.

Supplementary files

Supplementary Files Action
1.
Fig. 1. Posttraumatic choroidal neovascularization in a 7 year boy: a – the fundus image; b – structural optical coherence tomography; optical coherence tomography-angiography, 3 × 3 mm, choriocapillaris layer: c – before treatment; d – 2 days after the treatment (explanation in the text)

Download (556KB) Indexing metadata
2.
Fig. 2. Choroidal neovascularization in a 16 year old patient with pathalogical myopia, anterior-posterior axis – 27.6 mm, visual acuity before treatment – 0.2, after treatment – 0.9: a – the fundus image; optical coherence tomography-angiography, 3 × 3 mm, outer retinal layer (b), structural optical coherence tomography (c) before treatment; d – the fundus image; optical coherence tomography-angiography, 3 × 3 mm, the level of the external retina (e), structural OCT (f) in 2 months after the reinjection of angiogenesis inhibitors (explanation in the text)

Download (378KB) Indexing metadata
3.
Fig. 3. Choroidal neovascularization in a 17 year old patient with pathalogical myopia, anterior-posterior axis – 30,2, visual acuity – 0.05 and was stable during the whole follow up period: а – the fundus image at the first visit; b – after 2 months; c – structural optical coherence tomography; d – optical coherence tomography-angiography, 3 × 3 mm, the level of the external retina (explanation in the text). The arrows indicate the area of chorioretinal dystrophy

Download (452KB) Indexing metadata
4.
Fig. 4. Choroidal neovascularization associated with optic disc drusen in a 12 year old girl. Dynamic monitoring of the patient for 3 months: a–c – the fundus image; d–f – structural optical coherence tomography; g–i – optical coherence tomography-angiography 6 × 6 mm, the level of the exterrnal retina (explanation in the text)

Download (567KB) Indexing metadata
5.
Fig. 5. Choroidal neovascularization in a 9 year old girl with optic disc drusen: a – the fundus image of the right eye; b – optical coherence tomography-angiography 3 × 3 mm, choriocapillary level; c – structural optical coherence tomography before treatment; d – image of optic disc drusen of the right eye; e – autofluorescence; f – structural OCT after treatment (explanation in the text)

Download (371KB) Indexing metadata
6.
Fig. 6. Choroidal neovascularization in a 9 year old girl with optic disc drusen on the fellow eye: a – image of the optic disc drusen; b – optical coherence tomography-angiography 3 × 3 mm, choriocapillary level; c – structural optical coherence tomography of the left eye (explanation in the text). The arrow indicates the altered (as a result of rupture) pigment epithelium

Download (356KB) Indexing metadata
7.
Fig. 7. Choroidal neovascularization in a 13 years old boy with the morning glory syndrome: a – the fundus image; b – ultrasound scan; c – structural optical coherence tomography

Download (156KB) Indexing metadata

Statistics

Views

Abstract - 83

PDF (Russian) - 4

Cited-By


Article Metrics

Metrics Loading ...

PlumX

Dimensions


Copyright (c) 2021 Zhukova S.I., Samsonov D.Y., Zlobin I.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies