Bilateral choroidal neovascularization associated with optic nerve head drusen treated by antivascular endothelial growth factor therapy

Abstract

Objective: To report a good clinical outcome in a patient with bilateral choroidal neovascularization (CNV) associated with optic nerve head drusen (ONHD) treated with intravitreal ranibizumab injection.

Methods: A 12-year-old girl was referred for loss of right eye vision detected in a routine check-up. Best-corrected visual acuity (BCVA) was hand movements in the right eye and 0.9 in the left eye. Funduscopy revealed the presence of superficial and buried bilateral ONHD, which was confirmed by ultrasonography and computed tomography, and the study was completed with perimetry. The presence of bilateral CNV, active in the right eye, was observed and subsequently confirmed using fluorescein angiography and optical coherence tomography.

Results: Treatment with two consecutive injections of intravitreal ranibizumab resulted in inactivation of the neovascular membrane with subretinal fluid reabsorption and improved right eye BCVA. After 12 months' follow-up, this was 20/60 and stable.

Conclusion: Although there are no published studies of safety in children, antiangiogenic therapy for CNV secondary to ONHD may be useful and safe. A search of the literature produced only one previously reported case of ONHD-associated CNV treated with antivascular endothelial growth factor alone.

Keywords: anti-vegf; children; neovascularisation; optic nerve head drusen.

Figure 1

Optic nerve head drusen associated with an active choroidal neovascularization in the macular area on the right eye.

Figure 2

Fibrous choroidal neovascularization in the papillomacular bundle without activity on the left eye.

Figure 3

Ultrasound of (A) right eye and (B) left eye.

Figure 4

Computed tomography.

Figure 5

Initial fluorescein angiography.

Figure 6

Fluorescein angiography.

Figure 7

Optical coherence tomography of the right eye.

Figure 8

Visual field of the left eye.