First Author: B.Torres Ledesma SPAIN
Co Author(s): A. Lopez Masegosa P. Bueno Garcia L. F. Del Cotero Secades J. Botella Garcia J. Torres Pereda
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To demonstrate by a clinical case efficacy of aflibercept treatment in a child affected by peripapillary chroroidal neovascularization (CNV) secondary to optic nerve head drusen.
Retinal specialist consult
An eleven-year-old boy presented to our service with a non-painfull progressive vision loss on his left eye. The visual acuity was moving hands at 20 cm. Clinical examination revealed pseudopapilledema, optic nerve head drusen and a presumed peripapillary CNV associated with haemorrhage and exudates. We performed optical coherence tomography (OCT), fundus autofluorescence imaging, fluorescein angiography and echography. We also performed computed tomography and lumbar puncture in order to assess intracranial hypertension.
The OCT showed optic nerve drusen in both eyes and CNV in the left eye with intraretinal haemorrhage associated. The fluorescein angiography confirmed the existance of CNV. Echography showed optic nerve head drusen in both eyes. Intracranial pressure was normal. Targeting to minimize number of intravitreal injections, we chose aflibercept as initial shock therapy. Three injections of aflibercept were performed according to “treat and extend” model. One month after first injection best corrected visual acuity (Snellen) on the left eye was 20/50, with no blood remnants on the subretinal space. CNV decreased despite it remained active in OCT. After this, at the 3 years follow-up, visual acuity and fundus were stable without the recurrence of CNV.
Choroidal neovascularization caused by optic nerve head drusen are uncommon in children. Rapid spread to macular area leads to severe visuals sequels. In our case, intravitreal injections of aflibercept were effective in improving vision and reducing exudation of CNV secondary to optic nerve head drusen in a child. There were no complications or adverse reactions related to the treatment.