Optical coherence tomography in the diagnosis of choroidal neovascularization in children

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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.

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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

PhD, ophthalmologist

Russian Federation, 337 Lermontova str., Irkutsk, 664033

Dmitry Yu. Samsonov

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

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

PhD, ophthalmologist

Russian Federation, 337 Lermontova str., Irkutsk, 664033

Igor V. Zlobin

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

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

PhD, ophthalmologist

Russian Federation, 337 Lermontova str., Irkutsk, 664033

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2. 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)

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3. 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)

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4. 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

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5. 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)

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6. 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)

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7. 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

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8. 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

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

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