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Active surveillance of choroidal neovascularisation in children: incidence, aetiology and management findings from a national study in the UK
  1. Mariya Moosajee1,2,
  2. Alessandro Abbouda1,2,
  3. Barnaby Foot3,
  4. Catey Bunce4,
  5. Anthony T Moore2,5,
  6. James Acheson1
  1. 1Department of Paediatric Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, London, UK
  3. 3British Ophthalmological Surveillance Unit, Royal College of Ophthalmologists, London, UK
  4. 4Department of Ophthalmology, University of California, San Francisco, California, USA
  5. 5Department of Ophthalmology, UCSF School of Medicine, Koret Vision Center, San Francisco, California, USA
  1. Correspondence to Dr Mariya Moosajee, UCL Institute of Ophthalmology, London, EC1V 9EL, UK; m.moosajee{at}ucl.ac.uk

Abstract

Background/Aims To determine the UK incidence, demographics, aetiology, management and visual outcome for children developing choroidal neovascularisation (CNV).

Methods A prospective population-based observational study of routine practice via the British Ophthalmological Surveillance Unit between January 2012 and December 2013 with subsequent 1-year follow-up in children under 16 years old with newly diagnosed CNV.

Results Twenty-seven children with CNV were reported. The UK estimated annual incidence for those aged 16 and under was 0.21 per 100 000 (95% CI 0.133 to 0.299). The mean age was 11.1 years (SD 3.9, range 4–16). Fourteen were female. Seventy-seven per cent (22 patients) were Caucasian British. Twenty-three children (85%) had unilateral disease. The most common aetiology included inflammatory retinochoroidopathy (n=9), optic disc abnormalities (n=9) and idiopathic (n=5). Optical coherence tomography was performed in all cases and fundus fluorescein angiography in 61%. Management included observation only (n=10), anti-vascular endothelial growth factor (anti-VEGF) injection of bevacizumab (n=14) or ranibizumab (n=2), or both (n=1), and additional use of oral (n=1) and local (periocular n=2 and intravitreal n=2) steroids in five children with inflammatory retinochoroidopathy. The mean number of anti-VEGF injections was 2±1, with eight patients receiving only one injection. The mean (SD) best corrected visual acuity in LogMAR was 0.91 (0.53) at presentation and 0.74 (0.53) at 1-year follow-up (p=0.09).

Conclusion This is the first population-based prospective study of CNV in children. This is a rare disorder with a poor visual prognosis irrespective of CNV location and the use of anti-VEGF therapy.

  • neovascularisation
  • child health (paediatrics)

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Footnotes

  • Contributors MM: wrote the paper and carried out the research from conception. AA: undertook the analysis of questionnaires collected and contributed to writing the paper. BF: administrated the BOSU study and contributed to writing the paper. CB: statistician for the study, and analysed the incidence rates and outcomes collected contributed to writing the paper. ATM: cosupervisor of MM during study period, contributor of cases to the study and reviewed the paper. JA: cosupervisor of MM during study period, contributor of cases to the study and reviewed the paper.

  • Funding National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology Biomedical Research Centre and Fight for Sight UK.

  • Competing interests None declared.

  • Ethics approval Moorfields Eye Hospital and BOSU committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available and have been uploaded as supplementary data.

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