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Surgical management of subfoveal neovascularization in children
Insights
Submacular surgery improved vision in children with subfoveal membranes. Histopathology of these choroidal neovascular membranes was similar to adults.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pediatric Ophthalmology
Background:
- Subfoveal choroidal neovascularization (CNV) in children can impair vision.
- Limited data exists on surgical outcomes and histopathology of pediatric CNV.
Purpose of the Study:
- To describe clinical experience with submacular surgery for pediatric subfoveal membranes.
- To analyze histopathologic findings of these membranes.
Main Methods:
- Retrospective case series of 12 children undergoing vitrectomy and submacular membrane excision.
- Evaluation of visual acuity and membrane recurrence.
- Histopathologic analysis of excised membranes.
Main Results:
- Postoperative visual acuity improved significantly (median 20/80) compared to preoperative (median 20/300).
- Ten of 12 eyes showed improvement.
- Four eyes experienced recurrence; histopathology revealed retinal pigment epithelium, fibrocytes, vascular endothelium, and collagen.
Conclusions:
- Submacular surgery can benefit selected children with subfoveal neovascular membranes.
- Histopathologic findings resemble adult CNV not related to age-related macular degeneration.
Objective:
To report the authors' clinical experience with submacular surgery for subfoveal membranes in children and to evaluate the histopathologic findings of membranes in children with various etiologies of choroidal neovascularization.
Design:
Retrospective, noncomparative, interventional case series.
Participants:
Twelve eyes of 12 consecutive children with subfoveal choroidal neovascularization treated by vitrectomy and excision of the choroidal neovascular complex.
Intervention:
Vitrectomy, excision of the choroidal neovascular complex, and air-fluid exchange.
Main Outcome Measures:
Visual acuity and recurrence of choroidal neovascular membrane.
Results:
Preoperative visual acuities ranged from 20/60 to 20/800 (median, 20/300). Postoperative visual acuities ranged from 20/25 to 20/400 (median, 20/80) after an average follow-up of 20 months (range, 7-62 months). Ten of 12 eyes improved from immediate preoperative visual acuity, and four eyes developed recurrence of neovascular membranes over a mean follow-up of 18 months. Histopathologic examination of six excised membranes showed that the most common components of the membranes were retinal pigment epithelium, fibrocytes, vascular endothelium, and collagen.
Conclusion:
Selected eyes of children with subfoveal neovascular membranes and no evidence of membrane regression may benefit from submacular surgery. The histopathologic findings were similar to adult choroidal neovascularization not associated with age-related macular degeneration.
