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Bulgarian Review of Ophthalmology

Optical coherence tomography angiography as a follow-up method in a child treated with aflibercept due to myopic choroidal neovascular membrane

Ilian Shandurkov, Boryana Tomova, Yana Nikolaeva


Introduction: Optical coherence tomography angiography (OCTA) is a diagnostic method, based on high resolution imaging technology by which the retinal and choroidal circulation is visualized without injection of a contrast agent. This method is useful in cases, we want to avoid intravenous injection, but pathological vascular changes in macula have to be analyzed. 

Aim: The aim of this article is to present OCTA as a method of diagnostics and follow-up in the treatment of a child with myopic choroidal neovascular membrane (mCNVM). In addition to this we aim to discuss the indications for intravitreal application of afliberceptin children.

Materials and Methods: We present a case report of a 13-year-old girl with high myopia (-6.5 Dsph)  and sudden decrease of visual acuity, due to formation of mCNVM. The clinical diagnosis was confirmed by OCT and OCTA. After obtaining a written informed consent from both parents of the child, we performed an intravitreal injection of aflibercept (Eylea).The injection was repeated in 4 weeks due to OCTA data for mCNV.

Results: We used OCTA as a noninvasive method for diagnostics of pathology changes in the macula. This method demonstrated both regression of the choroid membrane andreduction of central foveal thickness, as a result of the performed treatment. The medicine used was aflibercept (Eylea), which is the only officially registered drug in Bulgaria for treatment of mCNV. The initial visual acuity of our patient was 0.2. After the first injection it reached 0.8 and in the end recovered to 1.0, after the second application of aflibercept. Since then, for a follow-up period of 15 months, no recurrence of the disease has been observed.

Conclusion: OCTA is a noninvasive method suitable for repeated examinations of macular circulation, which can replace fluorescein angiography (FAG) in establishment of diagnosis mCNV in children. Thus we can avoid all side effects and risks of FAG in young patients. Although there is no sufficient clinical data for the use of afliberceptin children, our mission as physicians is to use our knowledge for best available treatment for all patients.


ОСТ-ангиография при деца, aфлиберцепт при миопична ХНВ при деца

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About The Authors

Ilian Shandurkov
VISION Eye Hospital, Sofia

Boryana Tomova
VISION Eye Hospital, Sofia

Yana Nikolaeva
VISION Eye Hospital, Sofia