Choroidal Neovascularization in Pediatric Patients: Analysis of Etiologic Factors, Clinical Characteristics and Treatment Outcomes

Background and Objectives: Choroidal neovascularization (CNV) is a common pathologic lesion that occurs in various chorioretinopathy, but very limited published data have reported in pediatric patients. This study aimed to investigate the etiologic factors, clinical features, and treatment outcomes of choroidal neovascularization (CNV) in children.Methods: In this study, 33 eyes in 30 patients aged 18 years or younger with CNV were included. Comprehensive ophthalmic examination was performed in all the patients. The demographic profiles, laterality, visual acuity, optical coherence tomographic findings, fundus fluorescein angiographic findings, and the underlying pathology were analyzed. The types, locations, treatment outcomes, and recurrences of CNV were noted.Results: The average age was 11.2 ± 4.6 (range, 1–18) years. Most CNVs affecting children were classic and type 2. The most common etiologic factors of CNV in pediatric patients were congenital/developing abnormalities (9/30, 30.0%) and inflammatory retinochoroidopathy (9/30, 30.0%), followed by idiopathic CNV (8/30, 26.7%). Subtype analysis showed that the etiologic factor was inflammatory retinochoroidopathy in children 12 years or older, whereas congenital/developing abnormalities were present in children younger than 12 years. Eyes with active CNVs required a mean of 1.40 ± 0.58 injections. No recurrence was observed during follow-up.Conclusions: The etiologic factors of CNV in young Chinese patients were diverse, with congenital/developing abnormalities, inflammatory retinochoroidopathy and idiopathic CNV being the 3 most common ones. Eyes with active CNVs had good responses to antivascular endothelial growth factor treatment with low recurrence.

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Shortened Relative Leukocyte Telomere Length is Associated with Prevalent and Incident Cardiovascular Complications in Type 2 Diabetes- Analysis from the Hong Kong Diabetes Register

10.2337/figshare.12498335 ◽

2020 ◽

Author(s):

Feifei Cheng ◽

Andrea O Luk ◽

Claudia HT Tam ◽

Baoqi Fan ◽

Hongjiang Wu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Hong Kong ◽

Telomere Length ◽

Cox Regression ◽

Quantitative Polymerase Chain Reaction ◽

Hazard Ratio ◽

Chinese Patients ◽

Diabetes Register

Objective: Several studies support potential links between leukocyte relative telomere length (rLTL), a biomarker of biological aging and type 2 diabetes. This study investigates relationships between rLTL and subsequent cardiovascular disease (CVD) in patients with type 2 diabetes. Research design and methods: Consecutive Chinese patients with type 2 diabetes (N=5349) from the Hong Kong Diabetes Register with stored baseline DNA and available follow-up data were studied. rLTL was measured using quantitative polymerase chain reaction. CVD was diagnosed based on ICD-9 code. Results: Mean (SD) follow-up was 13.4(5.5) years. rLTL was correlated inversely with age, diabetes duration, blood pressure, HbA1c, urine ACR and positively with eGFR (all P<0.001). Subjects with versus without CVD at baseline had shorter rLTL (4.3±1.2 vs. 4.6±1.2, P<0.001). Of the 4541 CVD-free subjects at baseline, the 1140 who developed CVD during follow-up had shorter rLTL than those remaining CVD-free after adjusting for age, sex, smoking and albuminuria status (4.3±1.2 vs. 4.7±1.2, P<0.001). In Cox regression models, shorter rLTL was associated with higher risk of incident CVD (hazard ratio (95% CI) for each unit decrease: 1.252 (1.195-1.311), P<0.001), which remained significant after adjusting for age, sex, BMI, SBP, LDL-C, HbA1c, eGFR and ACR (hazard ratio (95% CI): 1.141 (1.084-1.200), P<0.001). Conclusions: rLTL is significantly shorter in type 2 diabetes patients with CVD, is associated with cardiometabolic risk factors, and is independently associated with incident CVD. Telomere length may be a useful biomarker for CVD risk in type 2 diabetes.

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Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort

Obesity Surgery ◽

10.1007/s11695-019-04069-y ◽

2019 ◽

Vol 29 (12) ◽

pp. 3978-3986

Author(s):

Yinfang Tu ◽

Liang Wang ◽

Li Wei ◽

Youhao Xu ◽

Xiaodong Han ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gastric Bypass ◽

Cost Utility ◽

Chinese Patients ◽

Multi Center Study ◽

Diabetes And Obesity ◽

Center Study

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Pediatric cerebellopontine angle and internal auditory canal tumors

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.6.peds1383 ◽

2013 ◽

Vol 12 (4) ◽

pp. 317-324 ◽

Cited By ~ 16

Author(s):

Michelle A. Holman ◽

William R. Schmitt ◽

Matthew L. Carlson ◽

Colin L. W. Driscoll ◽

Charles W. Beatty ◽

...

Keyword(s):

Family History ◽

Diagnostic Criteria ◽

Cerebellopontine Angle ◽

Pediatric Patients ◽

Pediatric Population ◽

Internal Auditory Canal ◽

Neurofibromatosis Type ◽

History Of

Object The aim in this study was to describe the clinical presentation, differential diagnosis, and risk for neurofibromatosis Type 2 (NF2) in pediatric patients presenting with cerebellopontine angle (CPA) and internal auditory canal (IAC) tumors. Methods The authors conducted a retrospective study at a tertiary care academic referral center. All patients with an age ≤ 18 years who had presented with an extraaxial CPA or IAC tumor between 1987 and 2012 were included in the study cohort. Data regarding symptoms, diagnosis, tumor characteristics, and NF2 status were collected and analyzed. Results Sixty patients (55% female, 45% male) harboring 87 tumors were identified. The mean age at diagnosis was 12.8 years (median 14.0 years, range 0.9–18.9 years). Schwannomas were the most commonly identified lesions (57 of 87 tumors, including 52 vestibular, 3 facial, and 2 trigeminal schwannomas), followed by meningiomas (5 of 87) and epidermoid cysts (4 of 87). Six malignant tumors were diagnosed, including small-cell sarcoma, squamous cell carcinoma, malignant meningioma, atypical rhabdoid-teratoid tumor, endolymphatic sac tumor, and malignant ganglioglioma. Headache, followed by hearing loss and imbalance, was the most common presenting symptom, whereas dysphagia, otalgia, and facial pain were uncommon. Neurofibromatosis Type 2 was diagnosed in 20 (61%) of 33 patients with vestibular schwannoma (VS), while the other 13 patients (39%) had sporadic tumors. Nineteen of the 20 patients with NF2 met the diagnostic criteria for that disorder on initial presentation, and 15 of them presented with bilateral VS. At the last follow-up, 19 of the 20 patients subsequently diagnosed with NF2 demonstrated bilateral VSs, whereas 1 patient with a unilateral VS and multiple other NF2-associated tumors has yet to demonstrate a contralateral VS to date. Only 1 patient presenting with an isolated unilateral VS and no family history of NF2 demonstrated a contralateral VS on subsequent radiological screening. Conclusions Cerebellopontine angle and IAC tumors in the pediatric population are rare. There are several noteworthy differences between the adult and pediatric populations harboring these lesions. While VS is the most common pathology in both age groups, the lesion was found in only 60% of the pediatric patients in the present study. Unlike in adults, VSs in the pediatric population were associated with NF2 in over one-half of all cases. The majority of pediatric patients with NF2 fulfilled the diagnostic criteria at initial presentation; however, approximately 7% of patients presenting with a seemingly sporadic (no family history of NF2) unilateral VS will meet the criteria for NF2 later in life. Finally, malignancies account for a significantly higher percentage (10%) of cases among pediatric patients. These findings underscore the importance of early screening and close radiological follow-up and may be helpful in patient counseling.

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Type D Personality Predicts Poor Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study

PLoS ONE ◽

10.1371/journal.pone.0146892 ◽

2016 ◽

Vol 11 (2) ◽

pp. e0146892 ◽

Cited By ~ 15

Author(s):

Xuemei Li ◽

Shengfa Zhang ◽

Huiwen Xu ◽

Xinfeng Tang ◽

Huixuan Zhou ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Medication Adherence ◽

Chinese Patients ◽

Follow Up Study ◽

Type D ◽

Poor Medication Adherence

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Increased Serum IGFBP-1 and Reduced Insulin Resistance After Roux-En-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes: a 6-Month Follow-Up

Obesity Surgery ◽

10.1007/s11695-018-3242-8 ◽

2018 ◽

Vol 28 (10) ◽

pp. 3165-3171 ◽

Cited By ~ 5

Author(s):

Zhigao Song ◽

Xiaojian Dai ◽

Hao Yu ◽

Qing Luo ◽

Hongbin Zhang ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Gastric Bypass ◽

Chinese Patients

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Intra-Vitreous Injections of Bevacizumab in Choroidal Neovascularization Complicating Best Vitelliform Macular Dystrophy: Case Report of a Child

Austin Journal of Clinical Case Reports ◽

10.26420/austinjclincaserep.2021.1220 ◽

2021 ◽

Vol 8 (7) ◽

Author(s):

Elkhoyaali A ◽

◽

Jeddou I ◽

Zerrouk R ◽

Khanaouchi N ◽

...

Keyword(s):

Choroidal Neovascularization ◽

Serous Retinal Detachment ◽

Retinal Hemorrhage ◽

Macular Dystrophy ◽

Vitelliform Macular Dystrophy ◽

Best Vitelliform Macular Dystrophy ◽

Sudden Decrease ◽

Best Disease

A 15-year-old child followed for Best vitelliform macular dystrophy presented to the clinic with an abrupt visual impairment of his left eye. Fundus examination showed bilateral vitelliform lesions, with serous retinal detachment and adjacent retinal hemorrhage in the left eye. Fluorescein angiography and optical coherence tomography confirmed the diagnosis of type-2 choroidal neovascularization complicating the Best disease. The juxtafoveal location of the choroidal neovascularization prompted us to realize monthly intra-vitreous injections of bevacizumab. After the fourth injection, we observed visual and anatomical improvement that remained stable after a 12-month follow-up. It’s important to look for complications in front of a sudden decrease in visual acuity in Best disease.

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Shortened Relative Leukocyte Telomere Length is Associated with Prevalent and Incident Cardiovascular Complications in Type 2 Diabetes- Analysis from the Hong Kong Diabetes Register

10.2337/figshare.12498335.v1 ◽

2020 ◽

Author(s):

Feifei Cheng ◽

Andrea O Luk ◽

Claudia HT Tam ◽

Baoqi Fan ◽

Hongjiang Wu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Hong Kong ◽

Telomere Length ◽

Cox Regression ◽

Quantitative Polymerase Chain Reaction ◽

Hazard Ratio ◽

Chinese Patients ◽

Diabetes Register

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Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization

10.21203/rs.2.21556/v2 ◽

2020 ◽

Author(s):

Qianru Wu ◽

Xiaoyong Chen ◽

Kang Feng ◽

Yuling Liu ◽

Chun Zhang ◽

...

Keyword(s):

Choroidal Neovascularization ◽

Disease Recurrence ◽

High Baseline ◽

Anti Vegf ◽

Factor Therapy ◽

The Mean ◽

Pro Re Nata ◽

Growth Factor Therapy ◽

Endothelial Growth Factor

Abstract Background This study aimed to evaluate the visual and morphological outcomes of intravitreal anti-VEGF therapy and the recurrence for idiopathic choroidal neovascularization (ICNV). Methods This retrospective study included 35 patients (35 eyes) with ICNV from July 2012 to October 2017. All patients received 1 intravitreal anti-VEGF injection followed by pro re nata injections until there was no sign of ICNV activity. This was defined as the first follow-up period. To evaluate ICNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest follow-up period was 5 years. Additional injection was performed when ICNV recurred. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded and morphological improvement in optical coherence tomography (OCT) was assessed. Parameters that affect prognosis and recurrence were analysed. Results The mean follow-up period was 168.0 ± 34.82 weeks. Mean BCVA improved from 56.20 ± 14.13 letters at baseline to 73.31 ± 12.57 letters (P＜0.01); Mean CRT decreased from 353.6 ± 98.70 μm at baseline to 273.1 ± 53.56 μm (P < 0.001) at the end of the first follow-up period. Better baseline BCVA indicated a better morphological improvement(P = 0.026) in OCT: the lesion had completely subsided with recovery of the foveal contour. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions (P = 0.036). ICNV recurred in six patients (22.2%), 1 of whom experienced 2 recurrences. The mean timing of recurrence was 90.83± 49.02 weeks after diagnosis. There was no significant correlation between ICNV recurrence and the morphological improvement (P = 0.633). The final BCVA in patients with recurrence did not differ from that in patients without recurrence (P=0.065). Conclusions Intravitreal anti-VEGF therapy on a pro re nata basis was effective for treating ICNV. High baseline BCVA indicated a better prognosis. Re-treatment with anti-VEGF could effectively lead to resolution of recurrent ICNV. Disease recurrence had no significant effect on final visual prognosis and had no correlation with the morphological improvement during treatment, suggesting that follow-up for subsequent monitoring should be performed in all ICNV patients.

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The Application of OCTA in Assessment of Anti-VEGF Therapy for Idiopathic Choroidal Neovascularization

Journal of Ophthalmology ◽

10.1155/2016/5608250 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Qin Chen ◽

Xiaobing Yu ◽

Zihan Sun ◽

Hong Dai

Keyword(s):

Optical Coherence Tomography ◽

Choroidal Neovascularization ◽

Retinal Layer ◽

Therapeutic Effects ◽

Optical Coherence ◽

Flow Area ◽

Anti Vegf ◽

Endothelial Growth Factor ◽

Sd Oct

Purpose. To assess the morphology of idiopathic choroidal neovascularization (ICNV) by optical coherence tomography angiography (OCTA) and determine the therapeutic effects of intravitreal antivascular endothelial growth factor (anti-VEGF).Method. Patients with naive ICNV were assessed by spectral domain optical coherence tomography (SD-OCT) and OCTA in this observational study. The timing of observation was before treatment, 1 day after treatment with intravitreal anti-VEGF injection, and 1 month after the treatment. The central retina thickness (CRT) on SD-OCT, selected CNV area, and flow area on OCTA were measured.Results. A total of 17 eyes from 17 patients with ICNV were included in this study. OCTA showed visible irregular choroidal neovascularization with “tree-in-bud” form on outer retinal layer. After treatment, as well as in the 1-day follow-up, CNV decreased in size from the periphery, and the vessel density was reduced. As shown on OCTA, the selected CNV area and flow area were significantly reduced compared to pretreatment. The rate of CNV vessel area changes was higher on OCTA than the changes in CRT on SD-OCT at 1-day and 1-month follow-up.Conclusion. Intravitreal injection of anti-VEGF is effective for idiopathic choroidal neovascularization, and the treatment outcomes are observable after 1 day. OCTA provides a useful approach for monitoring and evaluating the treatment of intravitreal anti-VEGF for CNV.

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