[Photodynamic therapy for choroidal neovascularisation due to choroidal coloboma in a 5 1/2-year-old child].

BACKGROUND: There are only few reports about the safety of photodynamic therapy (PDT) with verteporfin in secondary neovascularisations and only scarce reports about the PDT in children, only one of them in preschool-age children. We add the case of a 5 and a half-year-old child with choroidal neovascularisation due to choroidal coloboma. We treated this condition with PDT. PATIENT: A 5 and a half-year-old-child with choroidal coloboma in both eyes showed a switch of fixation from the right to the left eye and divergent strabismus switched to convergent strabismus, in addition a decrease in visual acuity from 0.4 to 0.04 was recorded. This was caused by a clinically visible subfoveal choroidal neovascularisation from the upper edge of the coloboma. Because no standard therapy is available for this special condition, we decided to treat the child with PDT.
RESULTS: PDT with verteporfin was performed without problems after motivation and support of the child by the parents (2.46 mL verteporfin, 4500 microm spot size, 83 seconds treatment time) and led to a complete scaring of the CNV after 14 days. At follow-up 3 and 6 months after therapy we documented only a moderate staining but no fluorescein leakage from the CNV and no macular oedema. Visual acuity increased after occlusion therapy within 24 months to 0.2 and fixation of the treated right eye was restored and resulted in intermittent fixation. Mean while the German "Bundessozialgericht" has decided on the reimbursement rules for this off-label use in very seldom diseases. No recurrence of the CNV was observed within the follow-up time of 5 and a half years.
CONCLUSION: This case proves that PDT is possible and safe in cooperative children including those in preschool age. PDT not only induced scaring of a CNV secondary to choroidal coloboma but also a return of the lost visual acuity.