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Updated: Jul 6, 2025
Author Spotlight: Overcoming Anti-VEGF Resistance Through Advanced Vascular Morphology Assessment in Choroidal Neovascularization
Published on: August 11, 2023
Longitudinal Characteristics of Choroidal Neovascular Membrane in Pediatric Patients
Sandra Hoyek1, Yifan Lu1, Shizuo Mukai1
1From the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Pediatric choroidal neovascular membranes (CNVMs) are often unilateral and idiopathic. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are effective and safe treatments for pediatric CNVMs, with OCTA showing improved vessel density.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Pediatric Eye Care
Background:
- Choroidal neovascular membranes (CNVMs) in children are rare but can lead to significant vision loss.
- Understanding the causes, characteristics, and effective treatments for pediatric CNVMs is crucial for optimal patient outcomes.
Purpose of the Study:
- To detail the clinical and imaging features, including optical coherence tomography angiography (OCTA), of pediatric CNVMs.
- To evaluate the treatment outcomes for children diagnosed with CNVMs.
Main Methods:
- A retrospective cohort study of 30 eyes from 25 children with CNVMs treated between 2005 and 2022.
- Clinical data, OCTA imaging, treatment regimens (primarily intravitreal anti-vascular endothelial growth factor [anti-VEGF] injections), and outcomes were analyzed.
Main Results:
- Idiopathic (48%) and inflammatory (20%) causes were most common for pediatric CNVMs, which were typically unilateral (80%) and active (83.3%).
- Intravitreal anti-VEGF therapy was the primary treatment (92%), with an average of 2.3 injections per eye and a 52.2% retreatment rate.
- Patients achieved a mean gain of 3 lines (15 ETDRS letters), and OCTA revealed decreased CNVM vessel density and retinal pigment epithelium detachment (RPED) height.
Conclusions:
- Pediatric CNVMs have diverse etiologies and are usually unilateral.
- Intravitreal anti-VEGF treatment is a beneficial and often non-chronic option for pediatric CNVMs.
- OCTA is valuable for monitoring treatment response, showing reduced CNVM vascularity and RPED height.
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.
