Paediatric Choroidal Neovascularisation of Unknown Cause

Choroidal neovascularisation (CNV) is a condition characterised by the proliferation of abnormal blood vessels within the choroid. These vessels tend to leak blood and fluid into the adjacent tissues, thereby causing harm to the retina and posing a threat to visual function. The infrequency of CNV in children can be attributed to its predominant association with age-related macular degeneration (AMD). The incidence of CNV in paediatric patients is generally considered to be very low, with rates often cited as being less than one case per 100,000 individuals annually. We present a 10-year-old female who was referred by an optician due to a one-month history of unilateral blurred vision in her left eye, leading to difficulties in reading the school board. The patient had no other past medical, trauma, or ocular history, and her family and developmental history were non-significant.  On examination, the patient's visual acuity measured 6/6 in the right eye and 6/9 in the left eye. Initial dilated fundal examination revealed a yellow hypopigmented, raised subfoveal lesion with irregular borders in her left eye; however, there was no evidence of neovascularisation or haemorrhage. The patient presented two weeks later with a sudden visual drop of 6/60. Fundal examination showed a new haemorrhage in the left eye, and subretinal fluid (SRF) was noted within the macula. Optical coherence tomography (OCT) and OCT angiography (OCT-A) identified an increase in SRF and confirmed a solitary CNV. The child received three loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) at one-month intervals, leading to complete resolution of SRF and haemorrhage on OCT. Consequently, the patient's visual acuity improved to 6/12. In summary, idiopathic CNV, although rare in paediatric patients, must be promptly diagnosed and adequately treated to guarantee resolution.