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  • Active surveillance of choroidal neovascularisation in children: incidence, aetiology and management findings from a national study in the UK

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Clinical science
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. 1 Department of Paediatric Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, London, UK
  3. 3 British Ophthalmological Surveillance Unit, Royal College of Ophthalmologists, London, UK
  4. 4 Department of Ophthalmology, University of California, San Francisco, California, USA
  5. 5 Department 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)

http://dx.doi.org/10.1136/bjophthalmol-2017-310445

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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.