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Photodynamic Therapy for Secondary Subfoveal Membrane in the Better Eye of a Six-year-old Child

1Rehfeldt K., 2Höh H.,
1Klinikum Neubrandenburg, Augenklinik (Neubrandenburg)
2Klinikum Neubrandenburg, Klinik für Augenheilkunde (Neubrandenburg)

Background: Secondary choroidal neovascularisation following inflammation or choroidal rupture has been successfully treated by PDT in individual cases. We report a six-year-old child with a classical subfoveal membrane arising from a choroidal coloboma.
Patient: The patient first presented at age 5 with exotropia OS and fixation of the right eye. Visual acuity was 0.4/0.2. Both fundi showed an inferior coloboma reaching superiorly to just below the fovea. 12 months later, her parents noted a change to esotropia with fixation OS. VA OD was reduced to 0.05. Fundus examination showed a subfoveal neovascular membrane arising from the superior border of the coloboma, with subretinal hemorrhage and edema. After detailed discussion with the parents, PDT was performed (2.46ml Visudyne, 83s, 4500µm).
Result: The six-year-old who was well-motivated by her parents underwent treatment without a problem. Two weeks after treatment, fluorescein angiography showed complete occlusion of the membrane. After three and six months, there was staining of the membrane but neither leakage nor significant edema. The retinal situation has been stable for 13 months now without recurrence of the membrane. VA after six months was 0.05 OD but improved to 0.2 at month 13 after patching of the left eye. The parents' lawsuit against the medical insurance company for reimbursement of the treatment fees is still pending.
Conclusions: PDT, and angiographic controls, could be performed in this very cooperative child. The secondary membrane due to choroidal coloboma was treated successfully and most of the lost visual acuity was regained. The results have been stable for 13 months now without need for retreatment.