Choroidal neovascularization in children: Etiology, diagnosis, and clinical manifestations

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Abstract

Few studies have analyzed choroidal neovascularization (CNV) in children because of the low incidence of this complication in pediatric ophthalmology. However, given the significant effect on visual acuity and diagnostic difficulties in children, the study of this complication is relevant.

AIM: This study aimed to analyze the etiological structure and clinical features of CNV in children.

MATERIAL AND METHODS: From 2014 to 2022, 61 eyes of 54 children (26 girls and 28 boys) had CNV. The patients underwent standard ophthalmologic examination and optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular zone and optic disc using the RS-3000 Advance 2 Tomograph (Nidek, Japan).

RESULTS: At the time of CNV diagnosis, the children were 5–17 years old, with a mean of 11±3 years. In 30 children (55.6%), CNV was caused by inflammatory lesions of the retina and choroid. Of these cases, 11 occurred during remission, whereas 21 occurred alongside pathologies of the retina, choroid, and optic nerve of noninflammatory genesis (8 of which were associated with Best’s disease). In three children, CNV was considered idiopathic. The development time of postinflammatory CNV ranged from 1 month to 12 years, with an average of 7.3±5 months from disease onset. Type 2 CNV was found in most cases (48 eyes, 78.7%).

CONCLUSION: CNV is a rare complication of various ocular diseases in children. In our cohort, it was most frequently observed in children with inflammatory lesions of the retina and choroid, even during remission. Patients at risk of CNV must be actively monitored because it occurs in various forms.

About the authors

Lyudmila A. Katargina

Helmholtz National Medical Research Center of Eye Diseases

Email: katargina@igb.ru
ORCID iD: 0000-0002-4857-0374

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Ekaterina V. Denisova

Helmholtz National Medical Research Center of Eye Diseases

Email: deale_2006@inbox.ru
ORCID iD: 0000-0003-3735-6249
SPIN-code: 4111-4330

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Natalya A. Osipova

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: natashamma@mail.ru
ORCID iD: 0000-0002-3151-6910
SPIN-code: 5872-6819

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Yana A. Kiseleva

Helmholtz National Medical Research Center of Eye Diseases

Email: drkiseleva@inbox.ru

resident doctor

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Ophthalmoscopic picture of an active choroidal neovascularization (arrow) in a child with central chorioretinitis of unclear etiology in remission.

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3. Fig. 2. Ophthalmoscopic picture of active choroidal neovascularization (arrow) in a child with choroidal osteoma. A focus with indistinct contours and perifocal hemorrhage at the edge of the osteoma is shown.

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4. Fig. 3. Ophthalmoscopic image of active choroidal neovascularization in a child with high-degree congenital myopia. A grayish proliferating focus with perifocal hemorrhage is shown.

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5. Fig. 4. Ophthalmoscopic image of subfoveolar active choroidal neovascularization in a child with optic disc drusen.

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6. Fig. 5. Optical coherence tomography (OCT) image of choroidal neovascularization type 2 in a child with toxoplasmosis retinochoroiditis in remission.

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7. Fig. 6. Optical coherence tomography (OCT) image of choroidal neovascularization type 1 in a child with chorioretinitis of unclear etiology in remission.

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8. Fig. 7. Optical coherence tomography angiography of active choroidal neovascularization. At the scanning level of the capillary layer of the ocular vasculature, a dense network of anastomosing newly formed vessels is detected.

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9. Fig. 8. Choroidal neovascularization: a, ophthalmoscopic picture corresponding to chorioretinitis in remission and inactive choroidal neovascularization; b, optical coherence tomography angiography showing active choroidal neovascularization in the chorioretinal focus.

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10. Fig. 9. Best’s disease, stage of cyst resorption: a, ophthalmoscopic picture; b, optical coherence tomography angiography, active choroidal neovascularization in the projection zone of lipofuscin-like substances.

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