ABSTRACT
BACKGROUND: Macular hemorrhages are a severe complication of other retinal pathologies, such as age-related macular degeneration (AMD) or macroaneurysms. Their therapeutic approach is not standardized, and can vary from observation to surgical treatment. MATERIAL AND METHODS: Retrospective analysis of 22 cases of macular hemorrhage, treated with vitrectomy associated to subretinal rTPA and intravitreal anti-VEGF over a period of 5 years. RESULTS: 22 eyes of 22 patients were included, of which 12 (52%) were women. The mean age at diagnosis was 84.4 years. 13 patients were pseudophakic (54.1%) and 19 (86.36%) had previous ophthalmological comorbidities. The etiology of the macular hemorrhage was AMD in 19 patients (86.36%). The mean of best VA corrected at diagnosis was 24.55 (Early Treatment Diabetic Retinopathy Study score -ETDRS), with a statistically significant improvement to 36.78 3 months after surgery (p = 0.011). With an average of 23.5 months of follow-up, no differences in prognosis associated with the etiology or size of the hemorrhage were observed. CONCLUSION: The treatment of macular hemorrhages by vitrectomy, subretinal rTPA and antiVEGF improves the visual prognosis of affected patients.
Subject(s)
Retinal Hemorrhage , Tissue Plasminogen Activator , Vascular Endothelial Growth Factors , Vitrectomy , Female , Humans , Intravitreal Injections , Macular Degeneration/complications , Macular Degeneration/drug therapy , Male , Retinal Hemorrhage/drug therapy , Retinal Hemorrhage/etiology , Retinal Hemorrhage/surgery , Retrospective Studies , Tissue Plasminogen Activator/therapeutic use , Vascular Endothelial Growth Factors/therapeutic use , Visual AcuityABSTRACT
Introducción: Las hemorragias maculares suponen una complicación severa de otras patologías retinianas, como la degeneración macular asociada a la edad (DMAE) o los macroaneurismas. El abordaje terapéutico de las mismas no se encuentra estandarizado, pudiendo variar desde la observación hasta el tratamiento quirúrgico.Material y métodosAnálisis retrospectivo de 22 casos de hemorragia macular, tratados mediante vitrectomías asociada a rTPA subretiniano y antiVEGF intravítreo durante un período de cinco años.ResultadosSe incluyeron 22 ojos de 22 pacientes, de los que 12 (52%) eran mujeres. La edad media al diagnóstico fue de 84,4 años. Del total de pacientes, 13 eran pseudofáquicos (54,1%) y 19 (86,36%) presentaban comorbilidades oftalmológicas previas. La etiología de las hemorragias maculares fue DMAE en 19 pacientes (86,36%). La media de mejor agudeza visual (AV) corregida al diagnóstico fue de 24,55 (puntuación Early Treatment Diabetic Retinopathy Study - ETDRS), con una mejoría estadísticamente significativa a 36,78 a los tres meses de la cirugía (p=0,011). Con un promedio de 23,5 meses de seguimiento, no se observaron diferencias en el pronóstico asociadas a etiología o tamaño de la hemorragia.ConclusiónEl tratamiento de las hemorragias maculares mediante vitrectomía, rTPA subretiniano y antiVEGF mejora el pronóstico visual de los pacientes afectos. (AU)
Background: Macular hemorrhages are a severe complication of other retinal pathologies, such as age-related macular degeneration (AMD) or macroaneurysms. Their therapeutic approach is not standardized, and can vary from observation to surgical treatment.Material and methodsRetrospective analysis of 22 cases of macular hemorrhage, treated with vitrectomy associated to subretinal rTPA and intravitreal anti-VEGF over a period of 5 years.Results22 eyes of 22 patients were included, of which 12 (52%) were women. The mean age at diagnosis was 84.4 years. 13 patients were pseudophakic (54.1%) and 19 (86.36%) had previous ophthalmological comorbidities. The etiology of the macular hemorrhage was AMD in 19 patients (86.36%). The mean of best VA corrected at diagnosis was 24.55 (Early Treatment Diabetic Retinopathy Study score -ETDRS), with a statistically significant improvement to 36.78 3 months after surgery (p = 0.011). With an average of 23.5 months of follow-up, no differences in prognosis associated with the etiology or size of the hemorrhage were observed.ConclusionThe treatment of macular hemorrhages by vitrectomy, subretinal rTPA and antiVEGF improves the visual prognosis of affected patients. (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Macular Degeneration/complications , Macular Degeneration/drug therapy , Retinal Hemorrhage/etiology , Retinal Hemorrhage/therapy , Tissue Plasminogen Activator/therapeutic use , Vascular Endothelial Growth Factors/therapeutic use , Vitrectomy , Retrospective Studies , Intravitreal Injections , Visual Acuity , PrognosisABSTRACT
OBJETIVO: Presentar el caso clínico de un paciente que presenta vasculopatía coroidea polipoidea (VCP) bilateral y degeneración macular asociada a la edad (DMAE) exudativa y atrófica, su tratamiento. Caso clínico. Mujer de 83 años presenta disminución de agudeza visual en el ojo izquierdo (OI). Al examen presenta DMAE atrófica en el OD, y en el OI una lesión naranja yuxtapapilar con depósitos lipídicos y otra gris subfoveal inferior. En la angiografía fluoresceínica y de verde de indocianina (AVI) se evidencia una membrana neovascular clásica en el OI, y pólipos yuxtapapilares en ambos ojos. Se realiza terapia fotodinámica con inyecciones anti-VEGF con estabilización de lesiones. CONCLUSIÓN: La coexistencia de la vasculopatía polipoidea coroidea y la DMAE exudativa es posible. Ante la sospecha de VCP debe realizarse AVI
OBJECTIVE: To present the case of simultaneous presentation of polypoidal choroidal vasculopathy (PCV) and aged-related macular degeneration (AMD). Case report. An 83-year-old woman presented with decreased vision in the left eye (LE). In the examination there was an orange peripapillary lesion surrounded by lipid exudates and another subfoveal greyish lesion in the LE. Disciform scarring was observed in the right eye. Fluorescein angiography showed a classic neovascular membrane in in the LE fovea. Indocyanine angiography (ICGA) showed a polyp-like peri-papillary aneurysmal dilation in both eyes. The patient was treated with photodynamic therapy and anti-VEFG injections with stabilisation of the lesions. CONCLUSION: PCV and AMD can co-exist in unusual cases. When PCV is suspected, ICGA is mandatory for diagnosis
Subject(s)
Humans , Female , Aged, 80 and over , Macular Degeneration/complications , Macular Degeneration/diagnosis , Refractive Errors/diagnosis , Refractive Errors/therapy , Phototherapy , Angiography , Electroretinography/instrumentation , Electroretinography/methods , RetinaABSTRACT
OBJECTIVE: To present the case of simultaneous presentation of polypoidal choroidal vasculopathy (PCV) and aged-related macular degeneration (AMD). CASE REPORT: An 83-year-old woman presented with decreased vision in the left eye (LE). In the examination there was an orange peripapillary lesion surrounded by lipid exudates and another subfoveal greyish lesion in the LE. Disciform scarring was observed in the right eye. Fluorescein angiography showed a classic neovascular membrane in in the LE fovea. Indocyanine angiography (ICGA) showed a polyp-like peri-papillary aneurysmal dilation in both eyes. The patient was treated with photodynamic therapy and anti-VEFG injections with stabilisation of the lesions. CONCLUSION: PCV and AMD can co-exist in unusual cases. When PCV is suspected, ICGA is mandatory for diagnosis.
Subject(s)
Choroid Diseases/complications , Choroid/blood supply , Macular Degeneration/complications , Aged, 80 and over , Female , Geographic Atrophy/complications , HumansABSTRACT
CASE REPORT: A case of benign concentric annular macular dystrophy is described. A 32-year-old woman presented with loss of quality in visual acuity. Ophthalmologic examination, fluorescein angiogram, electrophysiologic tests and visual field measurements were performed. DISCUSSION: It is very important to include in the differential diagnosis other dystrophies which present a <
Subject(s)
Pigment Epithelium of Eye , Retinal Diseases/diagnosis , Adult , Female , HumansABSTRACT
Caso clínico: Presentamos un caso clínico de distrofia macular anular benigna concéntrica. Se trata de una mujer de 32 años que se presenta con pérdida de calidad visual. Se realiza exploración oftalmoscópica, angiografía fluoresceínica, pruebas electrofisiológicas y campimetría. Discusión: Es de gran importancia realizar un cuidadoso diagnóstico diferencial con otras distrofias que presenten un patrón angiográfico en «ojo de buey», dado que la conservación de una relativamente buena agudeza visual es una característica señalada de esta enfermedad
Case report: A case of benign concentric annular macular dystrophy is described. A 32-year-old woman presented with loss of quality in visual acuity. Ophthalmologic examination, fluorescein angiogram, electrophysiologic tests and visual field measurements were performed. Discussion: It is very important to include in the differential diagnosis other dystrophies which present a «bulls eye» pattern on fluorescein angiography, given that preservation of relatively good visual acuity is a special feature of this disease
