Subretinal neovascularization associated with retinochoroidal coloboma

Chorioretinal Coloboma Complications: Retinal Detachment and Choroidal Neovascular Membrane

Purpose:

To report the chorioretinal coloboma, and its association with increased risk of retinal detachment (RD) and choroidal neovascularization (CNV).

Methods:

This retrospective case series included eyes with chorioretinal coloboma diagnosed between 1995 and 2014 with a focus on RD and CNV as related complications. Cases of CNV were managed with laser photocoagulation or intravitreal injection of bevacizumab. For eyes with CNV, therapeutic success was defined as resolution of the subretinal hemorrhage on fundus examination and resolution of the subretinal and intraretinal fluid on optical coherence tomography (OCT). For eyes with RD, anatomic success following surgical intervention was defined as attachment of the retina at the last follow-up visit.

Results:

Fifty-one eyes of 31 patients with chorioretinal coloboma were identified for review. Bilateral chorioretinal coloboma was present in 64.5% of subjects. RD developed in 15 eyes (29.4%). Among 15 eyes with RD, 4 eyes (27%) had retinal breaks identified within the coloboma, 5 eyes (33%) had retinal breaks outside the coloboma, 2 eyes (13%) showed retinal breaks both inside and outside the coloboma, and in 4 eyes (27%) the causative retinal break was not localized. The overall rate of anatomic success after RD repair was 85.7%. CNV developed in 7 eyes (13.7%) and was located along the margin of the coloboma in all cases. CNV was bilateral in 2 of the 5 affected individuals (40%).

Conclusion:

RD and CNV were present in a high percentage of eyes with chorioretinal coloboma in these series. The frequent finding of retinal breaks outside the coloboma bed suggests that vitreoretinal interface abnormalities may play a role in development of RD in these eyes.

Antivascular Endothelial Growth Factor Monotherapy for Choroidal Neovascularization Associated With Retinochoroidal Coloboma: Case Series

PURPOSE

This study aimed to report the outcomes of antivascular endothelial growth factor (anti-VEGF) monotherapy for choroidal neovascularization (CNVM) associated with retinochoroidal coloboma (RCC).

DESIGN

A retrospective case series.

METHODS

This was a case series of 3 eyes with CNVM associated with RCC that presented to the LV Prasad Eye Institute, Hyderabad, India, between January 2006 and January 2014. Reported data included demographics, preoperative details (symptoms, duration of symptoms, and visual acuity), treatment methods, and postoperative details (visual acuity, follow-up, and recurrence). These data were compared with 9 other cases previously reported in the literature.

RESULTS

Three eyes of 3 patients (2 females and 1 male) were included, with a mean age of 18.3 years (range, 2-32 years). The preoperative best corrected visual acuity ranged from 20/540 to 20/100. All 3 eyes were treated with intravitreal bevacizumab injections. The mean number of injections was 2.0 (range, 1-3) and mean duration of follow-up was 12 months (range, 4-24 months) with no recurrence. The best corrected visual acuity at the last follow-up was improved, ranging from 20/310 to 20/60.

CONCLUSIONS

In view of good treatment outcomes with no recurrence and a lesser number of injections, anti-VEGF monotherapy could be considered as treatment for coloboma-associated CNVM.

The development of recurrent choroidal neovascularization in a patient with choroidal coloboma

We report a case of recurrent choroidal neovascularization (CNV) in an eye with chorioretinal coloboma. A 36-year-old woman presented complaining of decreased visual acuity (VA) in her left eye. Best corrected visual acuity (BCVA) was 20/200 and iris coloboma was observed. Funduscopy and fluorescein angiography (FA) showed CNV in the superior extrafoveal region with chorioretinal coloboma reaching just inferior to the optic disc. No other cause for CNV was observed except for the chorioretinal coloboma. BCVA improved to 20/30 after laser photocoagulation. She revisited our clinic for deteriorating VA (20/400) in the same eye 3 years after treatment. Funduscopy and FA demonstrated recurrent CNV with subfoveal hemorrhage. Photodynamic therapy (PDT) was followed by three consecutive intravitreal bevacizumab injections (IVB) for the subfoveally-located CNV. However, the CNV persisted with the appearance of a fresh subretinal hemorrhage. Additional PDT was combined with IVB on the same day 6 months after the initial PDT. The CNV regressed 3 months after treatment and has not recurred as of 8 months after the last treatment. The patient's BCVA improved to 20/60. This case suggests that PDT combined with IVB can be an alternative treatment for the management of recurrent CNV after laser photocoagulation in eyes with chorioretinal coloboma.

Ranibizumab for coloboma-related choroidal neovascular membrane in a child

Optic nerve and retinochoroidal coloboma are caused by incomplete closure of the embryonic fissure during fetal development.(1) Affected patients carry a risk for retinal detachment and less so for choroidal neovascular membranes (CNVM) secondary to the altered anatomy. Because of the rarity of this condition and the even more unusual occurrence of such complications, there are only a few case reports on the treatment of coloboma-related CNVM. Herein we report the results of ranibizumab and laser photocoagulation for coloboma-related CNVM in a child.