Hemorragia submacular tras terapia fotodinámica en el tratamiento de la neovascularización coroidea / Submacular hemorrhage following photodynamic therapy in the treatment of choroidal neovascularization

Objetivo: Describir la incidencia, características clínicas y evolución de los pacientes que desarrollaron hemorragia submacular (HSM) tras terapia fotodinámica con verteporfino (TFD) en el tratamiento de la neovascularización coroidea (NVC). Método: Estudio retrospectivo de los pacientes tratados mediante TFD en nuestro servicio desde julio de 2002 hasta junio de 2005. Resultados: 8 de 504 ojos tratados con TFD (1,58%), desarrollaron HSM, de los cuales cuatro (0,79%) precisaron intervención quirúrgica. La incidencia por aplicación de TFD es de 0,65% (8/1221). En siete de los ocho casos (87,5%) la patología de base fue la degeneración macular asociada a la edad (DMAE), y en un caso (12,5%) la miopía magna. Respecto a la composición de la lesión, cinco eran ocultas (62,5%; p=0,01), una predominantemente clásica, una mínimamente clásica, otra no valorable. La AV final media era de 0,057, siendo >= 0,1 en 25% (2/8), con una pérdida media de 4 líneas de Snellen. Conclusiones: La HSM tras terapia fotodinámica es un suceso de etiología desconocida y poco frecuente. La incidencia de nuestra serie, 1,58%, está en el rango de lo publicado (0,24-9%). La mayor incidencia en DMAE y en las NVC ocultas sugiere que podrían tener un mayor riesgo de desarrollar una HSM. Se debe informar a los pacientes de la posibilidad de presentar esta complicación, que puede comprometer el resultado visual del tratamiento, y en ocasiones precisar cirugía. El bajo riesgo de HSM relacionada con el tratamiento, justifica su aplicación cuando éste está indicado

Purpose: To describe the incidence, clinical features and evolution of submacular hemorrhage (SMH) occurring after photodynamic therapy (PDT) with verteporfin in the treatment of choroidal neovascularization (CNV). Methods: A retrospective analysis of the patients treated with PDT in our hospital between July 2002 and May 2005 was undertaken. Results: 8 out of 504 eyes treated with PDT (1.58%) developed SMH; 4 of them (0.79%) required surgical attack. The incidence of SMH for every application of PDT was 0.65% (8/1221). The underlying disorder defined was age-related macular degeneration (AMD) in 7 cases (87.5%), and high myopia in one case (12.5%). Regarding the type of lesion, 5 were occult (62.5%; p=0.01), 1 predominantly classic, 1 minimally classic, and the last one was not classified. The average final visual acuity (VA) was 0.057, with 25% of patients having a VA >= 0.1. Patients lost 4 Snellen lines on average. Conclusions: SMH after PDT was an event of unknown etiology and low frequency. The incidence in our series (1.58%) was comparable with that described in the world literature (0.24-9.0%). The greatest incidence of AMD was in the occult group with no classic type of CNV, suggesting a possible higher risk for SMH in this type of lesion. It is mandatory to inform patients of the possibility of this complication, which can compromise the visual result of the PDT, and sometimes require surgery. The low risk of SMH related to the PDT justifies its application when it is indicated

[Results of treatment of retinal angiomatous proliferation with photodynamic therapy]. / Resultados del tratamiento de la proliferación angiomatosa retiniana mediante terapia fotodinámica.

PURPOSE: To determine the effects of phothodynamic therapy using verteporfin in the treatment of patients with retinal angiomatous proliferation (RAP) and the incidence of this retinal disease in our area. METHODS: We performed a retrospective study of 11 cases of RAP who were treated with photodynamic therapy using verteporfin (PDT). RESULTS: The incidence of RAP in the group of eyes with minimally classic or occult subfoveal choroidal neovascularization was 8%. The mean follow-up time after treatment was 15 months. The visual acuity improved in 3, remained the same in 4, and decreased in 4. In 4 patients, angiomatous lesions were observed in both eyes. CONCLUSIONS: There is no method proven to be effective for the treatment of retinal angiomatous proliferation. Our results suggest that PDT may be useful therapy in patients with RAP as it appeared to reduce the risk of visual loss.

Resultados del tratamiento de la proliferación angiomatosa retiniana mediante terapia fotodinámica / Results of treatment of retinal angiomatous proliferation with photodynamic therapy

Propósito: Determinar el efecto de la terapia fotodinámicacon el uso de verteporfino en el tratamientode pacientes con proliferación angiomatosaretiniana (PAR) y la incidencia de esta patologíaretiniana en nuestro medio.Métodos: Se presenta un estudio retrospectivo de11 casos diagnosticados de PAR y que fueron tratadoscon terapia fotodinámica con verteporfino.Resultados: La incidencia de PAR en el grupo deojos con neovascularización coroidea subfovealmínimamente clásica u oculta fue del 8%. El seguimientomedio fue de 15 meses. La AV mejoró en 3,permaneció igual en 4, y disminuyó en 4. 4 pacientespresentaban una lesión bilateral.Conclusiones: La proliferación angiomatosa retinianano tiene un tratamiento demostrado. Estosresultados sugieren que TFD puede ser una terapiaútil en pacientes con PAR y parece reducir el riesgode pérdida visual

Purpose: To determine the effects of phothodynamic therapy using verteporfin in the treatment of patients with retinal angiomatous proliferation (RAP) and the incidence of this retinal disease in our area. Methods:We performed a retrospective study of 11 cases of RAP who were treated with photodynamic therapy using verteporfin (PDT). Results: The incidence of RAP in the group of eyes with minimally classic or occult subfoveal choroidal neovascularization was 8%. The mean followup time after treatment was 15 months. The visual acuity improved in 3, remained the same in 4 , and decreased in 4. In 4 patients, angiomatous lesions were observed in both eyes. Conclusions: There is no method proven to be effective for the treatment of retinal angiomatous proliferation. Our results suggest that PDT may be useful therapy in patients with RAP as it appeared to reduce the risk of visual loss

[Submacular hemorrhage following photodynamic therapy in the treatment of choroidal neovascularization]. / Hemorragia submacular tras terapia fotodinámica en el tratamiento de la neovascularización coroidea.

PURPOSE: To describe the incidence, clinical features and evolution of submacular hemorrhage (SMH) occurring after photodynamic therapy (PDT) with verteporfin in the treatment of choroidal neovascularization (CNV). METHODS: A retrospective analysis of the patients treated with PDT in our hospital between July 2002 and May 2005 was undertaken. RESULTS: 8 out of 504 eyes treated with PDT (1.58%) developed SMH; 4 of them (0.79%) required surgical attack. The incidence of SMH for every application of PDT was 0.65% (8/1221). The underlying disorder defined was age-related macular degeneration (AMD) in 7 cases (87.5%), and high myopia in one case (12.5%). Regarding the type of lesion, 5 were occult (62.5%; p=0.01), 1 predominantly classic, 1 minimally classic, and the last one was not classified. The average final visual acuity (VA) was 0.057, with 25% of patients having a VA >or= 0.1. Patients lost 4 Snellen lines on average. CONCLUSIONS: SMH after PDT was an event of unknown etiology and low frequency. The incidence in our series (1.58%) was comparable with that described in the world literature (0.24-9.0%). The greatest incidence of AMD was in the occult group with no classic type of CNV, suggesting a possible higher risk for SMH in this type of lesion. It is mandatory to inform patients of the possibility of this complication, which can compromise the visual result of the PDT, and sometimes require surgery. The low risk of SMH related to the PDT justifies its application when it is indicated.

[Herpes simplex virus type 1 acute retinal necrosis two years after presumably herpetic meningoencephalitis]. / Necrosis retiniana aguda por virus herpes simplex tipo 1 dos años después de meningoencefalitis presuntamente herpética.

CASE REPORT: We report the case of a 53-year-old woman with uveitis in her right eye. She suffered from meningoencephalitis two years before. In the ophthalmic examination she showed no light perception, mild anterior uveitis and severe vitritis, which prevented from visualizing the retina. We suspected herpetic acute retinal necrosis (ARN), so therapy with intravenous acyclovir was started and a diagnostic vitrectomy was performed. Peripheral retinal necrosis and pallor of the optic disc were observed. PCR of the vitreous was positive for herpes simplex virus type I. DISCUSSION: This is probably a case of brain-to-eye virus transmission. According to this, the ARN would support the etiologic suspicion of the previous encephalitis.

Necrosis retiniana aguda por virus herpes simplex tipo 1 dos años después de meningoencefalitis presuntamente herpética / Herpes simplex virus type 1 acute retinal necrosis two years after presumably herpetic meningoencephalitis

Caso clínico: Mujer de 53 años remitida por uveítis OD, con antecedente de meningoencefalitis dos años antes. En la exploración no percibe luz y presenta uveítis anterior moderada, e intensa vitritis que impide explorar la retina. Se sospecha necrosis retiniana aguda (NRA) por virus herpes, se inicia tratamiento con aciclovir intravenoso y se realiza una vitrectomía diagnóstica, en la que se observa necrosis retiniana periférica y palidez papilar. El análisis por PCR de vítreo ha sido positivo para virus herpes simplex tipo 1.Discusión: Probablemente se trata de un caso de transmisión vírica cerebro-retiniana, según la cual la NRA apoya la sospecha etiológica de la encefalitis previa (AU)