Name

134 - Ablation chirurgicale de néovaisseaux rétrofovéolaires chez les enfants

To describe visual outcome and recurrence rate after surgical removal of submacular choroidal neovascular (CNV) membrane in children. 

This retrospective interventional case series included 7 eyes of 5 children that received pars plana vitrectomy with CNV membrane removal. Complete ophthalmological examination, including corrected-distance visual acuity (CDVA), biomicroscopic fundus examination and OCT assessment as well as examination under general anesthesia, when needed, were performed preoperatively and postoperatively at regular follow-up intervals. The need for intravitreal anti-VEGF injections was also assessed pre- and postoperatively.

Mean age at surgery was 5.9 years (range: 3.1-16). The cause of the CNV was idiopathic in 4 eyes (57.1%) and Best disease in 3 eyes (42.9%). All included CNVs were subfoveal with a median CDVA of 0.76 logMAR (range: 0.3-1.7). One child needed bilateral surgery. Median follow-up was 36 months (range: 5-156). ranged from 3 months to 13 years. All received preopertative anti-VEGF injection while only one eye needed postoperative injection. Median postoperative CDVA was  0.5 logMAR (range: 0-0.7). All eyes except one improve CDVA. Postoperative recurrent CNV developed in only one eye (14.7%) and was only treated with intravitreal anti-VEGF. One eye developed a self resolving intravitreal hemorrhage in the short post-operative period.

 It has been reported that subfoveal choroidal neovascular membranes in children and adolescents that show no signs of regression are often associated with severe visual loss secondary to disciform scar formation. In our series, CDVA improved from 0.76 logMAR to 0.5 logMAR. Recurrence rate was 14.7%, better than the rate of 30% reported by Sears et al. Furthermore, the outcomes of CNV ablation in the youngest cohort of children, median age of 5.9 years (range 3.1-16). Median age was of 16 years (range: 12-18) in the study of Uemura et al. and 11.5 years (range: 7-17) in the study of Sears et al.

PPV with subretinal CNV membrane removal is viable and safe treatment option for children with subretinal CNV membrane and low CDVA.