CHOROIDAL NEOVASCULARIZATION IN A CASE OF CHORIORETINAL COLOBOMA TREATED WITH INTRAVITREAL ANTI-VEGF INJECTONS: A CASE REPORT

Main Article Content

Dicky Budiman Simanjuntak Andi Arus Victor Gitalisa Andayani

Abstract

Introduction: Chorioretinal coloboma (CRC) results from abnormal closure of the embryonic fissure. Choroidal neovascularization (CNV) is a rare complication that associated with coloboma of the choroid. VEGF is an important factor in the development of CNV.


Case Report: A 52-year-old woman with gradual blurred vision of the left eye since 4 months ago. Right eye was already blurred since she was a child with uncorrected visual acuity (UCVA) was 0.5/60. Her right iris showed coloboma in inferior and chorioretinal coloboma. UCVA of the left eye was 6/20. Her left iris showed inferior coloboma, chorioretinal coloboma and macular edema with soft drusen. Macular optical coherence tomography (OCT) confirmed macular subretinal fluid, and indicated a CNV lesion of the left eye. She underwent a loading dose of three monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (bevacizumab) for the left eye. One month after completion of treatment, UCVA of the left eye improved to 6/12.


Discussion: CNV is a complication associated with CRC. Intravitreal Anti-VEGF treatment using loading dose regimen is shown to be effective in treating CNV. One month after completion of treatment, UCVA of the left eye improved.


Conclusion: Chorioretinal coloboma is a rare posterior segment congenital anomaly. Classical, bilateral coloboma of the choroid and iris indicates a deformation of the choroidal fissure closure. Coloboma of the choroid can have a complication such as choroidal neovascularization. Treatment with a loading dose of three monthly intravitreal anti-VEGF injections showed good anatomical and functional results.

Keywords

Chorioretinal coloboma, iris coloboma, choroidal neovascularization, intravitreal Anti-VEGF injections

Article Details

How to Cite
SIMANJUNTAK, Dicky Budiman; VICTOR, Andi Arus; ANDAYANI, Gitalisa. CHOROIDAL NEOVASCULARIZATION IN A CASE OF CHORIORETINAL COLOBOMA TREATED WITH INTRAVITREAL ANTI-VEGF INJECTONS: A CASE REPORT. International Journal of Retina, [S.l.], v. 5, n. 2, sep. 2022. ISSN 2614-8536. Available at: <https://www.ijretina.com/index.php/ijretina/article/view/124>. Date accessed: 10 dec. 2022. doi: https://doi.org/10.35479/ijretina.2022.vol005.iss002.124.
Section
Case Report

References

1. Gan NY, Lam WC. Retinal detachments in the pediatric population. Taiwan J Ophthalmol. 2018;8:222-36. 

2. Uhumwangho OM, Jalali S. Chorioretinal coloboma in a pediatric population. Eye. 2014;28:728-33. 

3. Chang L, Blain D, Bertuzzi S. Uveal coloboma: clinical and basic science update. Curr Opin Ophthalmol. 2006;17:447-70. 

4. Gupta V, Gupta A, Dogra MR. Subretinal neovascularization associated with retinochoroidal coloboma. Indian J Ophthalmol. 1997;45:116–7. 

5. Lee SH, Ahn JK, Yu HG. The development of recurrent choroidal neovascularization in a patient with choroidal coloboma. Korean J Ophthalmol. 2011;25:63–5.
6. Rouland JF, Constantinides G. Retinochoroidal coloboma and subretinal neovascularization. Ann Ophthalmol. 1991;23:61-2.
7. Bermejo E, Martinez-Frias ML. Congenital eye malformations: clinical-epidemiological analysis of 1,124,654 consecutive births in Spain. Am J Med Genet. 1998;75:497-504. 

8. Daufenbach DR, Ruttum MS, Pulido JS. Chorioretinal colobomas in a pediatric population. Ophthalmology. 1998;105:1455-8. 

9. Nakamura KM, Diehl NN, Mohney BG. Incidence ocular findings, and systemic associations of ocular coloboma: a population-based study. Arch Ophthalmol. 2011;129:69-74.
10. Gregory-Evans CY, Williams MJ, Halford S. Ocular coloboma: a reassessment in the age of molecular neuroscience. J Med Genet. 2004;41:881-91.
11. Chang L, Blain D, Bertuzzi S, Brooks BP. Uveal coloboma: clinical and basic science update. Curr Opin Ophthalmol. 2006;17:447-70.

12. Ozeki H, Shirai S, Nozaki M, Ikeda K, Ogura Y. Maldevelopment of neural crest cells in patients with typical uveal coloboma. J Pediat Ophthalmol Strabismus. 1999;36:337-41.
13. Blake KD, Issekutz KA, Smith IM, Prasad C, Graham JM. The incidence and prevalence of CHARGE syndrome. The CPSP annual report 2002 and 2003.
14. Hornby SJ, Adolph S, Gilbert CE. Visual acuity in children with coloboma: clinical features and a new phenotypic classi cation system. Ophthalmology. 2000;107:511-20.
15. Hussain RM, Abbey AM, Shah AR, Drenser KA, Trese MT, Capone A. Chorioretinal coloboma complications: retinal detachment and choroidal neovascular membrane. JOVR. 2017:12:3-9.
16. Bhende M, Suganeswari G, Gopal L, Bhende PS, Gopal L, Rao Chetan. Choroidal neovascularization associated with coloboma of the choroid: a series of three cases. Indian J Ophthalmol. 2011;59:148-51.
17. Gass JDM. Serous retinal pigment epithelial detachment with a notch; a sign of occult choroidal neovascularization. 1984;4:205-20.
18. Gass JOM. Radial chorioretinal folds; asign of choroidal neovascularization. Arch Ophthalmol. l981;99:1016-8.

19. Stanga PE, Lim JI, Hamilton P. Indocyanine green angiography in chorioretinal diseases: indications and interpretation: an evidence-based update. Ophthalmology. 2003;110:15–21.
20. Hee MR, Baumal CR, Puliafito CA, Duker JS, Reichel E, Wilkins JR, et al. Optical Coherence Tomography of Age,related Macular Degeneration and Choroidal
N eovascularization. 1996;1260-70.
21. Takenaka J, Yimane K, Minamoto A, Mishima HK, Hayashida H. Subretinal neovascularization associated with retinochoroidal coloboma. Eur J Ophthalmol. 2005;15:815‐7.
22. Gupta V, Gupta A, Dogra MR. Subretinal neovascularization associated with retinochoroidal coloboma. Indian J Ophthalmol. 1997;45:116‐7.
23. Maberley AL, Gottner MJ, Antworth MV. Subretinal neovascularization associated with retinochoroidal colobomas. Can J Ophthalmol. 1989;24:172‐4.
24. Brodsky MC, Ford RE, Bradford JD. Subretinal neovascular membrane in an infant with a retinochoroidal coloboma. Arch Ophthalmol. 1991;109:1650‐1.
25. Pe’er J, Shweiki D, Itin A. Hypoxia-induced expression of vascular endothelial growth factor by retinal cells is a common factor in neovascularizing ocular diseases. 1995;72:638-45. 

26. Gaudreault J, Fei D, Rusit J, Suboc P, Shiu V. Preclinical pharmacokinetics of ranibizumab (rhuFabV2) after a single intravitreal administration. Invest Ophthalmol Vis Sci. 2005;46:726-33.
27. Iu LP, Kwok AK. An update of treatment options for neovascular age-related macular degeneration. Hong Kong Med J. 2007;13:460-70. 

28. Berk AT, Yaman A, Saatci AO. Ocular and systemic findings associated with optic disc colobomas. J Pediatr Ophthalmol Strabismus. 2003;40:272-8. 

29. Vincent D, Venincasa VD, Modi YS. Clinical and Echographic Features of Retinochoroidal and Optic Nerve Colobomas. Invest Ophthalmol Vis Sci. 2015;56:3615-20.
30. Cagianut B. Eye manifestations in chromosomal disorders. Ophtalmologica. 1968;155:148-66.
31. Bain AD, Gauld IK. Multiple congenital abnormalities associated with ring chromosome. Lancet 2. 1963:304-5.
32. Wallace C. Anderson IF. Group B/D translocation chromosome in a case with stigmata of the D Trisomy. S.Afr Med J. 1964:325-35.
33. Naithani P, Vashisht N, Mandal S. Intravitreal bevacizumab in choroidal neovascularization associated with congenital choroidal and optic nerve coloboma in children: long-term improvement in visual acuity.
J AAPOS. 2010;14:288-90.Goodwin P, Shields CL, Ramasubramanian A. Ranibizumab for coloboma-related choroidal neovascular membrane in a child. J AAPOS. 2009;13:616-7.
35. Von EJ, Hoh H, Rehfeldt K. Photodynamic therapy for choroidal neovascularisation due to choroidal coloboma in a 5 1/2-year-old child. Klin Monbl Augenheilkd. 2007;224:140-5.
36. Rajendran A, Gupta S, Brahadeesh S. Intravitreal bevacizumab for choroidal neovascularization associated with a retinochoroidal coloboma. Eye. 2010;24:933-4.
37. Cohen SY, Bulik A, Dubois L, Quentel G. Photodynamic therapy for juxtafoveal choroidal neovascularization in myopic eyes. Am J Ophthalmol. 2003;136:371-4.
38. Parodi MB, Da Pozzo S, Ravalico G. Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopia. Acta Ophthalmol Scand. 2007;85:50-4.
39. Soubrane G, Pison J, Bornert P, Perrenoud F, Coscas G. Re ́sultats de la photocoagulation des ne ́ovaisseaux sous re ́tiniens de la myopie forte. Bull Soc Ophtalmol Fr. 1986;86:269-72.
40. Verteporfin Roundtable Participants. Guidelines for using verteporfin (Visudyne) in photodynamic therapy for choroidal neovascularization due to age-related macular degeneration and other causes: update. Retina. 2005;25:119-34.
41. Lipski A, Bornfeld N, Jurklies B. Photodynamic therapy with verteporfin in paediatric and young adult patients: long-term treatment results of choroidal neovascularisations. Br J Ophthalmol. 2008;92:655-60. 

42. Chang LK, Spaide RF, Brue C, Freund KB, Klancnik JM Jr, Slakter JS. Bevacizumab treatment for subfoveal choroidal neovascularization from causes other than age-related macular degeneration. Arch Ophthalmol. 2008;126:941-5.
43. Simo R, Hernandez C. Intravitreous anti-VEGF for diabetic retinopathy: hopes and fears for a new therapeutic strategy. Diabetologia. 2008;51(9):1574-80.
44. Kaiser PK. Antivascular endothelial growth factor agents and their development: therapeutic implications in ocular diseases. Am J Ophthalmol. 2006;142(4):660-8.
45. Amit L, Ben-Aharon I, Vidal L, Leibovici L, Stemmer S. The impact of Bevacizumab (Avastin) on survival in metastatic solid tumors, a meta-analysis and systematic review. PLoS One. 2013;8(1):51780.
46. Rajendran A, Gupta SR, Brahadeesh S, Ramasamy K. Intravitreal bevacizumab for choroidal neovascularization associated with a retinochoroidal coloboma. Eye. 2010;24:933‐4.
47. Naithani P, Vashisht N, Mandal S, Sankaran P, Garg S. Intravitreal bevacizumab in choroidal neovascularization associated with congenital choroidal and optic nerve coloboma in children: Long‐term improvement in visual acuity. J AAPOS. 2010;14:288‐90.
48. Bhende M, Suganeswari G, Gopal L, Bhende PS, Gopal L, Rao C. Choroidal neovascularization associated with coloboma of the choroid: A series of three cases. Indian J Ophthalmol. 2011;59:148‐51.
49. Brown DA, Regillo CD. Anti-VEGF agents in the treatment of neovascular age-related macular degeneration: Applying clinical trial result to the treatment of everyday patients. Am J Opthalmol. 2007;144:627-37.
50. Lalwani GA, Rosenfeld PJ, Fung AE. A variable-dosing regimen with intravitreal ranibizumab for neovascular age- related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol. 2009;148:43-58.
51. Fung AE, Lalwani GA, Rosenfeld PJ. An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol. 2007;143:566 -83.