Sir,

We have read with great interest the paper by Veloso, Costa, Oréfice, and Oréfice1 about spontaneous involution of choroidal neovascularization secondary to rubella retinopathy. The authors have presented to the scientific literature a very interesting and unusual case of bilateral choroidal neovascularization in a 10-year-old girl, with apparent good ocular health since birth, until 4 weeks before presentation, when she developed retinal epithelium mottling in both eyes (probably from birth) and an active subfoveal choroidal neovascular membrane in the right eye and an involutional similar lesion in the left eye. These findings were attributed to the fact that her mother contracted rubella during pregnancy.

In Brazil, where this patient was probably seen by the authors, the main ocular findings among infants born from mothers who contracted rubella during pregnancy are congenital cataract or a complete congenital rubella syndrome, which includes systemic and ocular manifestations like retinopathy with retinal epithelium mottling (as described in the correspondence by the authors), congenital cataract, glaucoma, iris hypoplasia, strabismus, microphthalmos, corneal leucoma, and even eye atrophy. Systemic complications of the rubella syndrome can also cause neurological, auditive, and cardiologic impairments in many patients.2, 3 Previous article from Brazil related congenital cataract in 42.7% among patients with systemic infections and around 38% of those patients had cataract formation secondary to congenital rubella.4

The decision assumed by the authors in only performing periodical observations of the patient's natural evolution without using any of the available treatments for subfoveal choroidal neovascularization including photodynamic therapy was really a correct decision. The current knowledge among researchers on subfoveal choroidal neovascularization in young patients secondary to inflammatory diseases as occurs in ocular toxoplasmosis, histoplasmosis, progressive subretinal fibrosis, and other similar situations states that these lesions normally show a natural involution of the neovascular complex even without any treatment.5 The reason for this remains unclear, as stated by the authors in the correspondence.

I wish to congratulate the authors for this really interesting contribution.