Recurrent myopic foveoschisis: resolution after internal limiting membrane removal / Isquise miópica recorrente: resolução após remoção da membrana limitante interna

We report a case of a 66-year-old man with a history of high myopia and who was referred for acute decreased visual acuity of the right eye. Fundus examination and optical coherence tomography (OCT) showed a mild epiretinal membrane (ERM) and splitting of retinal layers. Pars plana vitrectomy was performed with intravitreous triamcinolone injection, posterior hyaloid and ERM peeling, and 12% perfluoropropane (C3F8) gas tamponade. After remaining asymptomatic for 17 months, the patient reported a new episode of sudden decreased visual acuity in his right eye, and OCT showed recurrent myopic foveoschisis (MF). He underwent vitrectomy and internal limiting membrane (ILM) peeling. Six months later, the patient’s best corrected visual acuity had improved to 20/25. Optical coherence tomography showed a remarkably improved macular anatomy, with residual traction along the inferotemporal arcade, which was attributed to the vessel stiffness itself. We conclude that removing the internal limiting membrane is a challenging maneuver in myopic foveoschisis, even with staining approaches. Although myopic foveoschisis may be resolved without peeling the internal limiting membrane, its removal should be considered if the condition recurs.

Relatamos caso de um homem de 66 anos, com antecedente de alta miopia, que referiu baixa de acuidade visual aguda no olho direito. O mapeamento de retina e o exame de tomografia de coerência óptica (OCT) mostraram discreta membrana epirretiniana (ERM) e isquise retiniana. Foi realizada vitrectomia via pars plana com injeção intravítrea de triancinolona, retirada da hialóide posterior, peeling da membrana epirretiniana e tamponamento com gás perfluorpropano (C3F8) a 12%. O paciente permaneceu assintomático por 17 meses, quando queixou-se de novo episódio de baixa de acuidade visual súbita no olho direito e o tomografia de coerência óptica mostrou recorrência da isquise miópica. Ele foi submetido a nova vitrectomia com peeling da membrana limitante interna (ILM). Após 6 meses, a acuidade visual corrigida era de 20/25. A tomografia de coerência óptica mostrou melhora importante da anatomia macular, com área de tração residual observada na arcada inferotemporal, que foi atribuída à rigidez do próprio vaso. A retirada da membrana limitante interna é uma manobra desafiadora em olhos alto míopes, mesmo estando corada. A resolução da isquise miópica pode ser atingida sem o peeling da membrana limitante interna, mas sua remoção deve ser considerada em casos de recorrência.

Bevacizumab en el tratamiento de la neovascularización coroidea miópica / Bevacizumab in the treatment of myopic choroidal neovascularization

Objetivo: Determinar los efecto de bevacizumab intravítreo en el tratamiento de la membrana neovascular miópica. Métodos: Se realizó un estudio tipo cohorte retrospectiva de pacientes sometidos a inyección intravítrea de 1,25 mg de bevacizumab para el tratamiento de neovascularización coroidea miópica. Se evaluó cambios en agudeza visual (AV) mejor corregida, efectos secundarios y complicaciones. Resultados: 22 ojos fueron incluidos. La AV inicial fue de 0,17 +/- 0.15; al mes post-tratamiento de 0,28 +/- 0,15; a los 3 meses de 0,26 +/- 0,13; a los 6 meses de 0,21 +/-0,17; a los 12 meses de 0,31 +/- 0,13; a los 18 meses de 0,29 +/- 0,08; y a los 24 meses de 0,31 +/- 0,14. Hubo diferencia estadísticamente significativa entre el 1° y 12° mes en relación a la AV inicial. Conclusión: El tratamiento con bevacizumab intravítreo resultó en una significativa mejoría en la AV durante el primer año post-tratamiento.

Purpose: To determine the effects of intravitreal bevacizumab in the treatment of myopic choroidal neovascularization. Methods: A retrospective cohort study was performed by clinical history research of patients treated with 1,25 mg of intravitreal bevacizumab, with a follow up of 24 months. best corrected visual acuity (BCVA), side effects and complications were evaluated. Results: 22 eyes of 19 patients were included. Initial BCVA was 0.17 +/-0.15; at 1 month post treatment 0.28 +/- 0.15; at 3 months 0.26 +/-0.13; at 6 months 0.21 +/- 0.17; at 12 months 0.31 +/- 0.13; at 18 months 0.29 +/- 0.08; at 24 months 0.31 +/- 0.14. There was a significant statistical difference between the 1° and 12° month in contrast with the initial BCVA. Conclusions: Treatment with intravitreal bevacizumab resulted in a significant BCVA improve during the first year after treatment.

Eficacia y seguridad del bevacizumab (avastín) intravítreo en la neovascularización coroídea en miopía patológica / Efficacy and safety of intravitreal bevacizumab for myopic choroidal neovascularization

Resumen: Evaluar seguridad y eficacia a corto plazo del bevacizumab intravítreo en pacientes con neovascularización coroídea (NVC) en miopía patológica sin tratamiento previo. Diseño: Serie clínica consecutiva intervencional retrospectiva. Métodos: Siete pacientes recibieron bevacizumab intravítreo (1,5 mg). Se evaluaron los efectos secundarios, cambios en agudeza visual de Snellen (AV), características angiográficas y tomografía de coherencia óptica (OCT) al mes, tres y/o último mes de control post inyección. Resultados: No se encontraron efectos adversos. Al mes todos los pacientes presentaron desaparición de la filtración angiográfica y resolución del líquido subretinal en el OCT, con disminución media del grosor central de 73,3 um(p=0,01). La AV media mejoró de 0,2 a 0,4 (p=0,02) y de 0,2 a 0,5 (p=0,02) al primer y tercer mes respectivamente. Ningún paciente requirió retratamiento. Conclusiones: El bevacizumab intravítreo es bien tolerado y se asocia con mejoría de la AV en concomitancia con regresión de los signos angiográficos y al OCT de actividad de la NVC en miopía patológica.

Objective: To assess the short term efficacy and safety of intravitreal bevacizumab for myopic choroidal neovascularization (mCNV) without previous treatment. Methods: Intravitreal bevacizumab (1.5 mg) was injected into seven eyes of seven patients with mCNV in this non randomized, retrospective interventional case series. Changes in Snellen visual acuity (VA), optical coherence tomography (OCT) and fluorescein angiography (FA) were measured at 1,3 and/or last follow up month after treatment. Results: At one month all patients showed resolution of leakage from the mCNV in the FA and the mean foveal thickness on OCT images decreased 73.3 um (p=0.01). Mean VA improved from 20/100 to 20/50 (p=0.02) and from 20/100 to 20/40 (p=0.02) at 1 and 3 months post injection respectively. No retreatments were required. No major complications developed. Conclusion: Intravitreal injection of bevacizumab is well tolerated and in this small series seems to be safe and efficacious in eyes with mCNV.