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ABSTRACT
Choroidal neovascularization is rare in the pediatric population. It has been associated in this age group with a variety of conditions. Increasing ability to treat these neovascular lesions with laser photocoagulation makes early recognition very important for visual preservation.
An overview is presented, including an updated list of conditions associated with choroidal neovascularization in children and adolescents. Guidelines to recognition, parent and patient instructions, and the selective use of fluorescein angiography are emphasized. Five illustrative cases are highlighted, including a 10-year-old boy successfully treated with krypton laser photocoagulation near the fovea.
INTRODUCTION
Choroidal neovascularization (CNV) consists of new vessels of choroidal origin extending through Bruch's membrane into the sub-retinal-pigment-epithelial (subRPE ) or sub-neurosensory retinal space. The significance of these vessels was first recognized by Gass in 1967, when he suggested that they play a role in the pathogenesis of disciform macular detachment associated with senile macular degeneration1 and possibly with angioid streaks.2 In 1973, Gass demonstrated that CNV occurs in a variety of clinical syndromes and predisposes the eyes to serous and hemorrhagic macular detachment.3 A 4-year-old boy with CNV and optic nerve head drusen was reported as one of the case examples. Seven of the eight clinical syndromes reported by Gass to be associated with choroidal neovascular membranes can be seen in the pediatric population.3 The report also emphasized that good quality, rapidsequence fluorescein angiography (FA) is required for detecting CNV and determining candidates for photocoagulation treatment.
We wish to reacquaint the pediatric ophthalmologist with CNV, a sight-threatening but potentially treatable condition. A review of the literature, with reference to the pediatric age group, and five illustrative cases are presented. Guidelines to recognition, parent and patient instruction, and the selective use of FA are then emphasized. The Table represents the most complete and updated available list of conditions associated with CNV in children and adolescents.
CASE REPORTS
CASE 1: A 10-year-old boy had a 2-week history of metamorphopsia and slight blurring of vision of the right eye. Visual acuity was 20/40 OD and 20/20 OS. A small scotoma with surrounding metamorphopsia just inferior to fixation in the right eye appeared on Amsler grid viewing. Ophthalmoscopy revealed a small ring-shaped pigmented lesion just above the fovea of the right eye with a...