Outcomes and comparative analysis of therapeutic approaches for choroidal neovascular membranes associated with optic nerve head drusen in pediatric patients

Abstract

Background

Choroidal neovascular membranes (CNVM) associated with optic nerve head drusen (ONHD) are rare but vision threatening. A variety of treatments, including laser photocoagulation, subretinal surgery, and anti-VEGF injections, are effective but pose risks, particularly in pediatric patients, underscoring the need for a comprehensive review.

Methods

A systematic review was conducted using PubMed, Embase, and Web of Science. Studies with treated pediatric cases of ONHD and CNVM were included. Age >18 years, non-English-language articles, minimal/irrelevant data, and duplicate studies were excluded. Data about patient characteristics, treatment details, and visual outcomes were extracted.

Results

Of 309 screened publications, 28 studies with 29 patients were included. Of the 19 pediatric patients (22 eyes) receiving anti-VEGF treatment, best-corrected visual acuity (BCVA) improved from 0.84 ± 0.60 logMAR to 0.13 ± 0.15 logMAR (P < 0.0001). In the surgical or laser treatment cohort of 10 patients (12 eyes), BCVA improved from 0.76 ± 0.43 logMAR to 0.18 ± 0.15 logMAR (P = 0.0025). Anti-VEGF treatment was equally effective as surgical or laser treatment. We found no significant difference in the number of injections needed among anti-VEGF agents utilized (ranibizumab, aflibercept, and bevacizumab). No cases developed systemic or extraocular complications with anti-VEGF treatments. One case (5%) had a recurrence of CNVM after treatment.

Conclusions

This study reinforces the equal efficacy of surgical, laser, and anti-VEGF treatments for CNVM associated with ONHD in pediatric patients. No adverse outcomes of anti-VEGF therapy were reported.