Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in children

doi:10.1016/S0002-9394(02)02224-9

American Journal of Ophthalmology

Volume 135, Issue 6, June 2003, Pages 900-902

https://doi.org/10.1016/S0002-9394(02)02224-9 Get rights and content

Abstract

Purpose

To report the safety of photodynamic therapy with verteporfin in three children.

Design

Retrospective interventional noncomparative case series.

Methods

Children identified from all patients treated with verteporfin therapy at a university-based practice had records reviewed for adverse retinal or systemic events.

Results

Patients aged 11, 11, and 13 years, with subfoveal idiopathic choroidal neovascularization (CNV) received verteporfin therapy with no ocular complications recognized either immediately after the procedure or during the follow-up from 7 to 12 months. Treatment resulted in cessation of fluorescence leakage from CNV by the last follow-up visit in two patients and reduced leakage from the lesion in one. The visual acuity change was + 4, +7, and 0 lines.

Conclusion

Verteporfin therapy in three children with subfoveal CNV was associated with stable or improved vision during short-term follow-up in the absence of serious ocular or systemic adverse events.

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Age-related macular degeneration 2001. Preferred practice pattern from the American Academy of Ophthalmology. November...

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Cited by (34)

Longitudinal Characteristics of Choroidal Neovascular Membrane in Pediatric Patients
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To report the clinical and imaging characteristics, including optical coherence tomography angiography (OCTA), and treatment outcomes of choroidal neovascular membranes (CNVMs) in children.
Retrospective clinical cohort study.
Thirty eyes from 25 children (56% girls) with CNVM from 2 centers were examined from 2005 to 2022. Clinical features, imaging findings, treatment regimens, and outcomes are described.
The most common causes of CNVM were idiopathic (48%) and inflammatory (20%). At diagnosis, most CNVMs were unilateral (80%), active (83.3%), and juxtafoveal (46.7%). Twenty-five eyes (83.3%) of 21 patients (84%) were treated. The most common first-line treatment was intravitreal injection of anti–vascular endothelial growth factor (anti-VEGF) (92%), with a retreatment rate of 52.2% at an average of 237 days. The average number of total injections per eye was 2.3. Injections were safely administered in the clinic (52.2%). A gain of 3 lines or 15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters was observed at final visit. The average duration of follow-up was 56.46 ± 42.51 months. No ocular or systemic complication related to treatment was reported. Sixteen eyes (64%) had OCTA images at both presentation and final visit, which showed a decrease in CNVM vessel density and vessel-length density, and in the height of retinal pigment epithelium detachment (RPED).
There are a variety of underlying etiologies for pediatric CNVMs, which are most often unilateral. Treatment with intravitreal anti-VEGF can be beneficial and does not often require frequent or chronic dosing. OCTA demonstrated a decrease in the CNVM vessel density and vessel-length density as well as in the height of RPED.
Acquired and other retinal diseases (including juvenile X-linked retinoschisis)
2016, Taylor and Hoyt's Pediatric Ophthalmology and Strabismus, Fifth Edition
Associations with CNV in children and adolescents
2012, Pediatric Ophthalmology and Strabismus: Expert Consult - Online and Print
Idiopathic subfoveal choroidal neovascular membrane in a 21-month-old child: Ultrastructural features and implication for membranogenesis
2010, Journal of AAPOS
Citation Excerpt :
We thought that a wait-and-see approach with the hope of spontaneous resolution was not the best option in this case, with an actively leaking CNVM with a neurosensory detachment greater than twice the area of the CNVM in an infant at risk for deprivation amblyopia and having poor initial visual acuity and evidence for chronicity. Other treatment modalities, including laser photocoagulation7 and photodynamic therapy with verteporforin,8,9,11 have been used with some success in cases of pediatric CNVM. Macular laser photocoagulation is possible under anesthesia in a child this young, usually with the indirect-ophthalmoscope laser-delivery system.
To report the clinical and pathologic features of an idiopathic choroidal neovascular membrane (CNVM) in a 21-month-old child and to discuss the unique findings of infantile CNVM in the context of understanding the mechanism of membrane formation.
The CNVM was removed by submacular surgery. Light and electron microscopic tissue analyses were used to elucidate the structure and constituents of the CNVM.
Postoperative vision was 20/60 at 10 months without evidence of recurrence. Endothelium-lined vascular channels were observed within a membrane composed entirely of retinal pigment epithelial (RPE) cells with an associated fibrocollagenous and amorphous matrix. No inflammatory cells were identified. The RPE cells toward the inner (photoreceptor) side of the membrane exhibited a less-differentiated appearance, having lost their polarity and most of their cytoplasmic melanin granules. They secreted more prominent fibrils and mucopolysaccharides. Fenestrated endothelial cells surrounded by pericytes were present between the proliferating RPE cells.
Submacular surgery can be beneficial for idiopathic CNVM in pediatric patients, even at this early age. Proliferating RPE cells in the current membrane appear to be capable of performing all of the necessary functions associated with membranogenesis, even in the absence of inflammatory cells.
Intravitreal Bevacizumab (Avastin) for Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy, Secondary to Punctate Inner Choroidopathy, or of Idiopathic Origin
2007, American Journal of Ophthalmology
To evaluate the safety and efficacy of intravitreal bevacizumab in the treatment of idiopathic choroidal neovascularization (CNV) and CNV secondary to central serous chorioretinopathy (CSC) or punctate inner choroidopathy (PIC).
Prospective, nonrandomized, interventional case series.
In an institutional clinical practice, 15 patients were recruited; nine had idiopathic CNV, two had CNV secondary to CSC, and four had CNV attributable to PIC. Patients received three monthly 1.25-mg intravitreal bevacizumab injections for three months. Patients were followed for six months, and the best-corrected visual acuity (BCVA), fluorescein angiography (FA) findings, and optical coherence tomography (OCT) central foveal thickness (CFT) were assessed.
At baseline, the mean logMAR BCVA was 0.48 (Snellen equivalent = 20/60). The mean logMAR BCVA improved significantly to 0.25 (Snellen equivalent = 20/36) and 0.17 (Snellen equivalent = 20/30) at one and six months, respectively (both P = .001). The mean OCT CFT reduced from 306 μm at baseline to 201 μm at six months (P < .001). All eyes (100%) had visual improvement of 1 line or more at six months, and 11 (73.3%) improved by 2 or more lines. FA showed absence of CNV leakage, the angiographic end point, at three months, and no recurrence was observed at six months in all eyes. No systemic or ocular adverse events were encountered.
Intravitreal bevacizumab injections resulted in visual and anatomic improvements in eyes with idiopathic CNV and CNV attributable to CSC or PIC. Further studies are warranted to assess the long-term safety and the regimen for optimal efficacy of intravitreal bevacizumab.
Pediatric Choroidal Neovascularization
2023, Pediatric Vitreoretinal Surgery

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Brief reportPhotodynamic therapy with verteporfin for subfoveal choroidal neovascularization in children

Abstract

Purpose

Design

Methods

Results

Conclusion

Ophthalmology

Guidelines for using verteporfin (Visudyne) in photodynamic therapy to treat choroidal neovascularization due to age-related macular degeneration and other causes

Retina

Brief report
Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in children