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Citation: Saadouli D, Ben Mansour K, Zouara H, Yahyaoui S, Mahdhi S, El Afrit MA. Choroidal neovascular membrane: Report of pediatric idiopathic
case. Jr.med.res.2020;3(3): 15-19. Abid et al © All rights are reserved. https://doi.org/10.32512/jmr.3.2.2020/15.19
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Case report
Saadouli Dorsaf
1,3, **
,
Ben Mansour Khaoula
1,3
, Zouara Haifa, Yahyaoui Salem
2,3,*
, Mahdhi Sameh
1,3
, El Afrit Mohamed Ali
1,3
.
Choroidal neovascular membrane: Report of pediatric idiopathic case.
1: Department of ophthalmology La Rabta
Hospital, Tunis, Tunisia
2: Department of Pediatrics C, Children
Hospital, Tunis, Tunisia
3: College of medicine Tunis Tunisia
* Corresponding author
** Academic Editor
Correspondence to:
yahyaouisalem@yahoo.fr
Publication Data:
Submitted: August 28,2020
Accepted: October 30,2020
Online: November 30,2020
This article was subject to full peer-
review.
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The choroid neovascular membrane is a rare cause of central vision loss among
children. Its etiopathogenesis is still unclear and the management is not
standardized. The neovascularization may be due to inflammatory, post-traumatic,
or dystrophic causes. We described herein a case of choroidal neovascular
membrane in a 14-year-old boy with no evident origin after investigations.
Keywords:
choroidal neovascular membrane, idiopathic, child.
Introduction
Choroidal neovascularization (CNV) in children is a rare entity which may lead to
serious visual impairment [1]. In literature, its association with inflammatory,
infectious, dystrophic, and traumatic disorders has been always reported.
However, their etiopathogenesis is still unclear [2]. Several therapeutic options are
available, but the treatment is still case-based and usually extrapolated from the
adult patient’s management.
In this work, we propose to highlight the clinical, therapeutic and prognostic
characteristics of CNV in pediatric practice.
Observation
A 14-year-old female without previous medical history presented with progressive
bilateral blurry vision. On examination, she had a sciascopy of +1.5 diopter at the
right eye and +1 diopter at the left one. The best corrected visual acuity in both
eyes was 4/10 on the Snellen scale.
Anterior segment examination by slit lamp was normal. Intraocular pressures were
normal. The examination of the fundus showed a greyish macular bilateral lesion
suggestive of a neovascular membrane (Fig1). Fluorescein angiography showed an
early macular dye leakage increasing at the intermediate phase and persisting at
the late phase (fig 2). Macular optical coherence tomography scan (OCT) showed
a bilateral hyperreflective fibrovascular complex located above retinal pigment
epithelium layer (fig 3). OCT-A scan revealed a glomerular pattern CNV at the right
eye and a tree-like pattern at the left eye (fig 4). Exhaustive etiological assessment
was performed. The complete blood count, the erythrocyte sedimentation rate, the
CRP, the renal and liver function were normal. Quantiferon and tuberculosis test
were negative. We eliminated traumatic and iatrogenic causes.
Serological tests of syphilis, toxoplasmosis, cat scratch disease, herpes and
cytomegalovirus were negative. Hemostasis analysis and hemoglobin
electrophoresis were also normal. Best's disease complicated by new vessels was
unlikely as the family history and the results of electrophysiological exploration (fig
5 a and b) were negative. The general pediatric examination did not reveal any
abnormalities. Finally, we retained the diagnosis of bilateral idiopathic retro
foveolar choroidal neovascular membrane. Intravitreal injection of anti VEGF and
photodynamic therapy (PDT) were considered.
Abstract
Choroidal neovascular membrane: Report of pediatric idiopathic case.
Citation: Saadouli D, Ben Mansour K, Zouara H, Yahyaoui S, Mahdhi S, El Afrit MA. Choroidal neovascular membrane: Report of pediatric idiopathic
case. Jr.med.res.2020;3(3): 15-19. Abid et al © All rights are reserved.
Submit your manuscript: www.jmedicalresearch.com
16
Figure 2: Fluorescein angiography (FA) showed an early persistent macular dye leakage
Figure 1: Fundus photography suspected macular bilateral lesion making ½ papillary diameter suggestive of a neovascular
Membrane.
Choroidal neovascular membrane: Report of pediatric idiopathic case.
Citation: Saadouli D, Ben Mansour K, Zouara H, Yahyaoui S, Mahdhi S, El Afrit MA. Choroidal neovascular membrane: Report of pediatric idiopathic
case. Jr.med.res.2020;3(3): 15-19. Abid et al © All rights are reserved.
Submit your manuscript: www.jmedicalresearch.com
Figure 3: Linear horizontal trans-foveolar scan (Spectral HD OCT) showed a bilateral hyperreflective fibrovascular complex located above retinal
pigment epithelium layer.
Figure 3: OCT-A scan revealed a glomerular pattern CNV at the right eye and a tree-like pattern at the left eye.
17
Choroidal neovascular membrane: Report of pediatric idiopathic case.
Citation: Saadouli D, Ben Mansour K, Zouara H, Yahyaoui S, Mahdhi S, El Afrit MA. Choroidal neovascular membrane: Report of pediatric idiopathic
case. Jr.med.res.2020;3(3): 15-19. Abid et al © All rights are reserved.
Submit your manuscript: www.jmedicalresearch.com
Figure 5: Electrooculogram
Figure 3 Per-operative findings of giant pseudo meningocele and a size-increased dural defect.
18
Choroidal neovascular membrane: Report of pediatric idiopathic case.
Citation: Saadouli D, Ben Mansour K, Zouara H, Yahyaoui S, Mahdhi S, El Afrit MA. Choroidal neovascular membrane: Report of pediatric idiopathic
case. Jr.med.res.2020;3(3): 15-19. Abid et al © All rights are reserved.
Submit your manuscript: www.jmedicalresearch.com
Discussion
Choroidal neovascularization (CNV) is a neoformation of capillaries penetrating the Bruch's membrane, the retinal
pigment epithelium and later potentially into the subretinal space [1]. Pediatric choroidal neovascular membranes
(CNVM) are uncommon and may cause severe visual impairment. CNVMs may be secondary to traumatic, infectious,
inflammatory, tumoral or dystrophic causes. More than 15% of CNVMs in young patients are idiopathic [2].
Etiopathogenesis of the inappropriate proliferation of the choroidal capillaries remains unclear. The focal choroiditis
and choroidal ischemia may explain the capillaries neoformation but not the extensive behavior regarding the retinal
and subretinal spaces [3]. The diagnosis has been made easier with the introduction of the Optical coherence
tomography angiography (OCTA) that captures three-dimensional angiograms of retinal and choroidal blood vessels
and allows the detection of CNVM [4]. The management of idiopathic CNVMs is still nonconsensual due to the lack of
randomized pediatric trial. Recent reports showed promising stable anatomical and visual outcomes with the anti-
vascular endothelial growth factor therapy (VEGF) [5,6].
Conflict of Interest: None
References
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