Spontaneous regression of idiopathic choroidal neovascularization in a child with 3‑year follow‑up and a meta‑analysis of anti‑VEGF therapy for pediatric choroidal neovascularization of different etiologies

<title>Abstract</title> <p> Background Pediatric choroidal neovascularization (CNV) is rare, and its natural history remains poorly understood. Both adults and children with CNV treated with anti-vascular endothelial growth factor (VEGF) therapy, a well-established CNV treatment, have a good prognosis. However, there is inadequate evidence to confirm its treatment safety and efficacy, and different CNV etiologies may also have different outcomes. Methods We report a 12-year-old child with idiopathic CNV who was followed for 3 years with serial multimodal imaging, including optical coherence tomography angiography and fundus fluorescein angiography. Additionally, we performed a systematic review and meta-analysis of anti-VEGF therapy in pediatric CNV (PROSPERO: CRD 420261368733). PubMed, Embase, Web of Science, CNKI, and WanFang Data were searched from their inception to May 2026. Studies that included children (&lt; 18 years) with CNV treated with anti-VEGF were selected. The primary outcome was a change in the best-corrected visual acuity (BCVA). Secondary outcomes included the number of injections, central macular thickness change, anatomical response, and adverse events. Random-effects models were used. Results The case showed complete spontaneous CNV regression over 3 years, with vision improving from 0.5 to 0.8 (logMAR 0.3 to 0.1). Bilateral short band-like hypofluorescence on FFA indicated inactive CNV with retinal pigment epithelium hyperplasia. The meta‑analysis included 20 studies (1477 eyes). Anti‑VEGF therapy significantly improved the BCVA (mean difference − 0.28 logMAR; 95% CI − 0.35 to − 0.22; I ²  = 53.5%; moderate certainty). The mean number of injections was 2.50 (95% CI 2.16–2.84; high heterogeneity). The anatomical response rate was 95% (95% CI 84%–99%; moderate certainty). Adverse events were rare. A subgroup analysis showed no significant difference based on etiology (p = 0.84). Conclusion Idiopathic pediatric CNV can spontaneously regress over long-term follow-up. Anti-VEGF therapy is effective and safe for active pediatric CNV. Observation may be a reasonable alternative for carefully selected low-activity, extrafoveal idiopathic cases. </p>