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.