Tratamiento de la neovascularización coroidea miópica / Treatment of myopic choroidal neovascularization

Se realizó una revisión sobre el tratamiento de la neovascularización coroidea en la miopía degenerativa. Se consultaron fundamentalmente artículos científicos de revistas publicados e indexados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema. No se encontraron certezas del beneficio de la fotocoagulación con láser de las lesiones neovasculares en esta entidad, mientras que la terapia fotodinámica parece brindar estabilidad de la lesión y mejoría visual, al menos a los 3 años de seguimiento. El uso de antiangiogénicos intravítreos tiene los mejores resultados en la actualidad respecto a la inactivación de la lesión y la recuperación visual pero no hay ensayos clínicos controlados que avalen su beneficio a largo plazo. Otras opciones de tratamiento se encuentran en investigación y desarrollo. No se ha concebido el protocolo ideal para tratar las membranas neovasculares miópicas

A literature review on the treatment of the choroidal neovascularization in the degenerative myopia was made. Published scientific articles of journals indexed in Pubmed and Cochrane databases, as well as basic texts that deal with this topic. No evidences of the benefits of the laser photocoagulation for neovascular lesions were found, whereas the photodynamic therapy seems to offer stability of the lesion and visual improvement after three years of follow-up. The use of intravitreous antiangiogenic drugs has currently achieved the best results in terms of lesion inactivation and visual recovery, but there are no controlled clinical trials that support their long-term benefits. Other treatment options are under research and development. The ideal protocol of treatment of neovascular myopic membranes has not yet been devised

Resultados del tratamiento con ranibizumab de la neovascularización coroidea en degeneración macular asociada a la edad durante el periodo de Enero 2011-Diciembre 2012 en el Hospital Edgardo Rebagliati Martins-Lima / Results of treatment with ranibizumab for choroidal neovascularization in macular degeneration associated with age during the period January 2011-December 2012 at the Hospital Edgardo Rebagliati Martins, Lima

Introducción: La degeneración macular asociada a la edad (DMAE) es una enfermedad prevalente en pacientes de la tercera edad. Tiene prevalencia incrementada por aumento en la expectativa de vida, es un problema de salud pública por ser una causa importante de ceguera; por muchos años no ha tenido un tratamiento eficaz para la detención o prevención de dicha enfermedad. Los anti-VEFG (vascular endotelial factor growth) son el tratamiento de elección. El ranibizumab es un anti-VEFG aprobada por la FDA (2004) para el tratamiento de la forma húmeda de la degeneración macular asociada a la edad. Se ha demostrado en diversos estudios de ensayos clínicos fase III como ANCHOR y MARINA, la mejora y mantenimiento de la agudeza visual (AV), en nuestro estudio nosotros evaluamos los resultados de nuestro tratamiento con ranibizumab en 2 años de seguimiento. Métodos: Fueron revisadas las historias clínicas de los pacientes sometidos a tratamiento de la membrana neo vascular asociada a la DMAE, durante los años 2011-2012, consignando los datos estadísticos sexo, edad, AV pre tratamiento, AV post tratamiento, grosor macular central pre y post tratamiento, complicaciones oculares y sistémicas. Resultados: Se trataron 83 pacientes el 51,8 por ciento masculinos, mientras que el 48,2 por ciento femenino. Con una edad media de 73,36, siendo el pico de la prevalencia de la enfermedad entre los 65-85 años. La media del número de dosis fue de 4,52 por persona; La media de agudeza visual antes del tratamiento fue de 0,1923 (Snellen=20/104), y luego del pos tratamiento de 0,3429 (Snellen=20/58), 10 que representa una ganancia media de 10 letras, luego de concluido el tratamiento (p=0,00). El espesor macular tiene una media de 408,57 micras antes del tratamiento versus una media de 324,16 micras luego de instalado el tratamiento, con una variación media de 84,4 micras (p=0,00). No se reportó ninguna complicación ocular ni sistémica secundaria al uso de ranibizumab. La enfermedad...

Background: The age-related macular degeneration (ARMD) is a disease prevalent in patients of the third age, has prevalence a greater life expectation. Is a problem of public health for being an important cause of blindness. For many years it not had an effective treatment or prevention of the above mentioned disease. The anti- VEFG is treatment choice now. The ranibizumab is an anti-VEFG approved by the FDA (2004) for the treatment of the "wet" form of ARMD, it ~as been demonstrated in several studies of clinical tests ANCHOR and MARINA phase III, the improvement and maintenance of the visual acute (V A). In our study we evaluate the results of our treatment with ranibizumab in 2 years of follow-up. Method: We studied the clinical histories of the patients submitted to treatment of the neo vascular membrane associated with ARMD, during the years 2011-2012, recording the statistical information sex, age, VA pre treatment, V A post treatment, central retinal thickness pre and post treatment also ocular and systemic complications. Results: 83 patients treated 51, 8 per cent masculine and 48,2 per cent feminine. With a middle ages of 73, 36 being the peak of the prevalence of the disease between 65-85 years. The average of the number of dose was of 4, 52 for person; The average of VA before the treatment was of 0,1923 (Snellen=20/104), and after the pos treatment of 0,3429 (Snellen=20/58), which represents an average profit of 10 letters, after concluded the treatment (p=0,00). The central macular thickness has an average of 408,57 microns before the treatment versus an average of 324,16 microns after post treatment, with an average variation of 84,4 microns (p=0,00). There have not any ocular complications or systemic secondary to the use of ranibizumab. The most frequent systemic disease was the arterial hypertension 36,1 per cent, diabetes mellitus 9,6 per cent, others not mentioned were the obesity, chronicle renal disease (1,2 per cent), and a group of...

Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: Short-term results.

Aims: To compare the short-term therapeutic effects of intravitreal bevacizumab (IVB) to those of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). Materials and Methods: Retrospective interventional case study. Eighty-nine eyes of 89 patients with symptomatic PCV were treated by IVB or PDT. Eighteen eyes were treated with a single injection of IVB (s-IVB group), 22 eyes with three consecutive monthly IVB injections (m-IVB group), and 49 eyes with PDT alone (PDT group). The best-corrected visual acuity (BCVA) and OCT-determined central foveal thickness (CFT) were evaluated before, and one and three months after the treatment. For statistical analyses, one-factor ANOVA and Chi-square test were used. Results: The differences in the BCVA and CFT among the three groups at the baseline were not significant (P=0.992, P=0.981, respectively). Three months after the treatment, the BCVA improved by >0.2 logMAR units in two out of 18 eyes (11%) in the s-IVB group, three out of 22 eyes (14%) in the m-IVB group, and 15 out of 49 eyes (31%) in the PDT group (P=0.124). A decrease in the CFT by >20% was achieved in six out of 18 eyes in the s-IVB group, ten eyes (46%) in the m-IVB group, and 35 eyes (71%) in the PDT group (P=0.009). The resolution of polyps was achieved in three out of 18 eyes in the s-IVB group, one eye (5%) in the m-IVB group and 35 eyes (71%) in the PDT group (P<0.001). Conclusion: The better short-term therapeutic outcomes in the PDT group than in the s-IVB and m-IVB groups indicate that PDT may be more effective than IVB in short term after treatment for PCV.

Inflammatory choroidal neovascular membrane in posterior uveitis—pathogenesis and treatment.

Choroidal neovascular membrane (CNVM) formation is a well-documented sight-threatening complication of posterior segment intraocular inflammation (PSII). The aim of this article is to review the basic and clinical science literature on the pathogenesis of CNVM formation in PSII and to present results of a case series. We searched the literature using the mesh terms- inflammation, CNVM, age-related macular degeneration, immunosuppression, photodynamic therapy, steroids, vascular endothelial growth factors and posterior uveitis. Additionally, we evaluated the visual outcome of and clinical response to our standard treatment protocol involving a combination treatment for young patients with inflammatory CNVM. The development of CNVM in PSII is promulgated by infiltrating myeloid cells as well as choroidal and retinal myeloid cell activation, subsequent vascular endothelial growth factors, cytokine and chemokine production and complement activation acting in consort to mediate angiogenic responses. No clear standard of care currently exists for the treatment of inflammatory CNVM and various combinations have been tried. Using our combination treatment, visual acuity improved in four, stabilized in one and worsened in four patients. Though significant advances have occurred in the understanding of the pathogenesis and management of this condition, optimizing therapeutic regimens will require further well-constructed prospective cohort series.

Toxoplasmosis retinochoroiditis after photodynamic therapy and intravitreal triamcinolone for a supposed choroidal neovascularization: a case report

The purpose is to report a complication after photodynamic therapy (PDT) and intravitreal triamcinolone for a presumed choroidal neovascularization in age-related macular degeneration. Photodynamic therapy and intravitreal triamcinolone were used in an 84-year-old man with choroidal neovascularization in the left eye. Forty-five days after therapy, the patient returned with a severe necrotizing uveitis in the posterior pole and vitritis. Laboratory investigation disclosed a high anti-Toxoplasma IgG titer. Therapy with pyrimethamine, sulfadiazine and folinic acid resulted in total lesion healing although central vision was lost. Intravitreal triamcinolone may have had an influence on the exacerbation of retinochoroiditis in the posterior pole of the patient. Although rare, this complication may not be disregarded in the cases that require intraocular corticosteroids for treatment of several conditions, especially in patients who had previously suffered from toxoplasmosis infection.

O objetivo é relatar complicação após terapia fotodinâmica (PDT) e triancinolona intravítrea para presumida neovascularização de coróide em degeneração macular relacionada à idade. A terapia fotodinâmica e triancinolona intravítrea foram utilizados em paciente de 84 anos, do sexo masculino, com neovascularização de coróide no olho esquerdo. Quarenta e cinco dias após o tratamento, o paciente retornou com grave retinite necrosante do pólo posterior e vitreíte. Investigação laboratorial indicou alto título de IgG anti-Toxoplasma. Tratamento com pirimetamina, sulfadiazina e ácido folínico levaram à total cicatrização da lesão embora a visão central tenha sido comprometida. Conclui-se que a triancinolona intravítrea pode ter influenciado na exacerbação da retinocoroidite no pólo posterior do paciente. Embora rara, esta complicação não pode ser descartada nos casos que necessitem corticóide intra-ocular para tratamento de várias doenças, principalmente em pacientes que tenham tido surtos prévios de toxoplasmose ocular.

Terapia fotodinâmica da neovascularizaçäo coroideana na degeneraçäo macular relacionada à idade com verteporfirina / Photodynamic therapy with verteporfirin for choroidal neovascularization caused by age related macular degeneration

A degeneraçäo macular senil é a principalcausa de cegueira legal em vários países do mundo ocidental e, atualmente, a maior causa de perda de visäo em pessoas acima de 50 anos. Este trabalho foi realizado com a finalidade de determinar se a terapia fotodinâmica com Verteporfirina pode reduzir com segurança o risco de perda de visäo nos pacientes com neovascularizaçäo coroideana com Degeneraçäo Macular Relacionada à Idade (DMRI). Trinta e cinco pacientes com DMRI foram submetidos à injeçäo de Verteporfirina (Visudyne), com subseqüente aplicaçäo de laser, de comprimento de onda de 690 nm, durante 83 segundos. Tais pacientes foram analisados quanto à acuidade visual pré e pós-tratamento, bem como quanto à regressäo ou näo da membrana neovascular. Dos 35 olhos estudados, a Membrana Neovascular Subretiniana (MNVSR) mostrou sinais de regressäo em 29 (82,86 por cento) deles. Nestes olhos a membrana era do tipo clássica ou predominantemente clássica. Em 6 (17,14 por cento) pacientes, näo houve regressäo da membrana. Quatro deles possuíam MNVSR com padräo angiográfico do tipo oculto e em 2 olhos a membrana era predominantemente clássica, porém muito espessa e extensa, näo havendo alteraçöes de suas características. Ocorreu recidiva em 11 (31,42 por cento) olhos. Houve melhora da visäo em 18 (51,42 por cento) pacientes; em 14 (40 por cento) pacientes manteve-se nos mesmos valores pré-tratamento; e em 3 pacientes houve piora da acuidade visual.A través desse estudo vemos que a Terapia Fotodinâmica é um bom método para controle da degeneraçäo macular relacionada à idade, principalmente quando a lesäo possui componente clássico e näo oculto. O seguimento desses pacientes, entretanto, ainda é muito pequeno para que conclusöes de mais longo prazo possam ser tiradas