Características clínicas de la coriorretinopatía exudativa hemorrágica periférica en un centro de referencia en España / Clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy in a referral center in Spain

Objetivo: Publicar las características clínicas de la coriorretinopatía exudativa hemorrágica periférica (CEHP) en la población española. Métodos: Estudio retrospectivo y análisis de los resultados en pacientes con diagnóstico de CEHP. Fueron recogidas las características clínicas, por OCT, el tratamiento utilizado y la evolución posterior al tratamiento. Resultados: Se evaluaron 39 ojos de 23 pacientes con CEHP. La edad promedio al diagnóstico fue de 79 años (66-94 años). El síntoma ocular principal fue la disminución de visión en 26 ojos (66,6%), siendo 11 ojos (28,2%) asintomáticos. El diagnóstico de referencia más frecuente fue sangrado/exudación en 24 ojos (61,5%), le siguió melanoma coroideo con 9 (23,1%). Las hemorragias intra o subretinianas fueron el tipo de lesión periférica más frecuentemente encontrado, en 24 ojos (61,5%). Veinticinco ojos (58,9%) recibieron algún tipo de tratamiento: A 15 ojos (60%) se les realizó inyección intravítrea (IIV) de antioangiogénicos (anti-VEGF); se realizó fotocoagulación con láser en 2 casos (8%), terapia fotodinámica en 2 casos (8%) y 6 casos (18,2%) precisaron vitrectomía vía pars plana (VPP) por hemorragia vítrea. No hubo cambios en la agudeza visual (AV) en los pacientes seguidos con observación entre el inicio 0,66±0,80 (0,04-2,82) y el fin de seguimiento 0,75±0,96 (0,00-2,82) (p=0,352), ni para los que recibieron algún tipo de tratamiento entre inicio 0,78±0,79 (0,04-2,30) y fin 1,22±1,01 (0,04-2,82) (p=0,157), posiblemente debido al gran componente de degeneración macular asociada con la edad (DMAE) atrófica o exudativa presente en ambos grupos (29 ojos presentaron DMAE atrófica o exudativa). Conclusiones: La CEHP es una enfermedad poco frecuente, asociada frecuentemente con DMAE, que se presenta típicamente como una masa periférica que se confunde frecuentemente con melanoma...(AU)

Objective: To publish the clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy (PHEC) in the Spanish population. Methods: Retrospective study and analysis of results in patients diagnosed with PHEC. The clinical characteristics, by OCT, the treatment used and the evolution after treatment were collected. Results: 39 eyes of 23 patients with PHEC were evaluated. The average age at diagnosis was 79 years (66-94 years). The main ocular symptom was low vision in 26 eyes (66.6%); only 11 eyes (28.2%) were asymptomatic. The most frequent referred diagnosis was bleeding/exudation in 24 eyes (61.5%), followed by choroidal melanoma in 9 (23.1%). Intra or subretinal hemorrhages were the type of peripheral lesion most frequently found, in 24 eyes (61.5%). Twenty-five eyes (58.9%) received some type of treatment: 15 eyes (60%) underwent intravitreal injection (IIV) of antiangiogenic agents (anti-VEGF); Laser photocoagulation was performed in 2 cases (8%), Photodynamic therapy in 2 cases (8%) and 6 cases (18.2%) required pars plana vitrectomy (PPV) due to vitreous hemorrhage. There were no changes in visual acuity (VA) in patients followed with observation between baseline 0.66±0.80 (0.04-2.82) and end of follow-up 0.75±0.96 (0.00-2.82) (P=.352), nor for those who received some type of treatment between the beginning 0.78±0.79 (0.04-2.30) and the end 1.22±1.01 (0.04-2.82) (P=.157), possibly due to the large component of atrophic or exudative age-related macular degeneration (AMD) presented in both groups. (29 eyes presented atrophic or exudative AMD). Conclusions: PHEC is a rare pathology, frequently associated with AMD, which typically presents as a peripheral mass that is frequently confused with choroidal melanoma and other intraocular tumors and hence the importance of learning to identify it, making the correct differential diagnosis and avoid unnecessary treatments. Antiangiogenic therapy is effective in most patients with...(AU)

Clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy in a referral center in Spain.

OBJECTIVE: To publish the clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy (PHEC) in the Spanish population. METHODS: Retrospective study and analysis of results in patients diagnosed with PHEC. The clinical characteristics, by OCT, the treatment used and the evolution after treatment were collected. RESULTS: 39 eyes of 23 patients with PHEC were evaluated. The average age at diagnosis was 79 years (66-94 years). The main ocular symptom was low vision in 26 eyes (66.6%); only 11 eyes (28.2%) were asymptomatic. The most frequent referred diagnosis was bleeding/exudation in 24 eyes (61.5%), followed by choroidal melanoma in 9 (23.1%). Intra or subretinal hemorrhages were the type of peripheral lesion most frequently found, in 24 eyes (61.5%). Twenty-five eyes (58.9%) received some type of treatment: 15 eyes (60%) underwent intravitreal injection (IIV) of antiangiogenic agents (anti-VEGF); Laser photocoagulation was performed in 2 cases (8%), Photodynamic therapy in 2 cases (8%) and 6 cases (18.2%) required pars plana vitrectomy (PPV) due to vitreous hemorrhage. There were no changes in visual acuity (VA) in patients followed with observation between baseline 0.66±0.80 (0.04-2.82) and end of follow-up 0.75±0.96 (0.00-2.82) (P=.352), nor for those who received some type of treatment between the beginning 0.78±0.79 (0.04-2.30) and the end 1.22±1.01 (0.04-2.82) (P=.157), possibly due to the large component of atrophic or exudative age-related macular degeneration (AMD) presented in both groups. (29 eyes presented atrophic or exudative AMD) CONCLUSIONS: PHEC is a rare pathology, frequently associated with AMD, which typically presents as a peripheral mass that is frequently confused with choroidal melanoma and other intraocular tumors and hence the importance of learning to identify it, making the correct differential diagnosis and avoid unnecessary treatments. Antiangiogenic therapy is effective in most patients with an active phase (exudative/hemorrhagic) into leading to fibrosis of peripheral hemorrhagic areas.

[Outcomes of macular hole surgery using three different surgical techniques]. / Resultados de la cirugía del agujero macular con diferentes técnicas de tratamiento.

PURPOSE: To compare the effectiveness, efficiency and complications of three different surgical techniques employed for the treatment of macular holes between 1998 -2004 in our health care centre. METHODS: A retrospective, comparative, and non-randomized study of 131 eyes with macular holes, stage III and IV, treated with three different surgical techniques was performed. Vitrectomy was performed in 25 eyes (group 1). Vitrectomy was associated with internal limiting membrane peeling in 19 eyes (group 2), and in the remaining 87 eyes, the peeling of the retinal internal limiting membrane was assisted with indocyanine green (ICG) (group 3). The concentrations of ICG used were 5%, 2.5% and 0.5%. We compared the anatomic and functional results, and the complications which occurred. RESULTS: The overall anatomic success rate was 88.4% (114 eyes), and it was higher in group 3 (90.6%). A visual acuity improvement was achieved in 63.6% of eyes; however there were no significant differences between the groups studied. The most important complications included cataracts (51.9%), increase in intra-ocular pressure (37.2%), retinal detachment (7.8%) and retinal pigment epithelial changes (7%). These pigment epithelial changes were associated with the use of ICG-assisted peeling (p<0.05), but there was no correlation between the changes and the concentration of ICG employed. The hole size had an inverse correlation with initial and final visual acuity. An epi-retinal membrane was associated with better visual acuities and higher anatomic success. CONCLUSIONS: In our experience, the use of ICG-assisted internal limiting membrane peeling in macular hole surgery improves the anatomic success, but may lead to retinal pigment epithelial changes.

Resultados de la cirugía del agujero macular con diferentes técnicas de tratamiento / Outcomes of macular hole surgery using three different surgical techniques

Objetivo: Comparar la efectividad, eficiencia y complicaciones de las tres técnicas quirúrgicas empleadas en el tratamiento del agujero macular en el período 1998-2004 en nuestro centro. Métodos: Estudio retrospectivo, comparativo, intervencionista y no aleatorizado de 131 ojos con agujero macular idiopático en estadío III y IV, operados con tres técnicas. En 25 ojos se realizó vitrectomía simple (grupo 1), en 19 ojos se asoció rexis de la membrana limitante interna (MLI) (grupo 2), y en 87 ojos esta rexis se llevó a cabo previa tinción con verde de indocianina (ICG) (grupo 3). Las concentraciones de ICG empleadas fueron del 5%, 2,5% y 0,5%. Se compararon la recuperación anatómica y funcional y las complicaciones en los distintos grupos. Resultados: El 88,4% (114 ojos) lograron la resolución anatómica, siendo superior en el grupo 3 (90,6%). La recuperación funcional se consiguió en el 63,6%. En ambos casos no existieron diferencias entre grupos. Las complicaciones más importantes fueron: cataratas post-cirugía (51,9%), aumento de PIO (37,2%), desprendimientos de retina (7,8%) y alteraciones del epitelio pigmentario (7%). Esta última se relacionó con el uso de ICG (p<0,05), sin encontrarse diferencias en las concentraciones empleadas. El tamaño del agujero tuvo una correlación inversa con la agudeza visual (AV) inicial y post-quirúrgica. La presencia de membrana epirretiniana se asoció a mejores AV y a un mayor éxito anatómico. Conclusiones: En nuestra experiencia, la cirugía mejora la AV, siendo más efectiva si se asocia ICG para la rexis de la MLI. Sin embargo, esta tinción podría estar relacionada con las alteraciones del EPR encontradas

Purpose: To compare the effectiveness, efficiency and complications of three different surgical techniques employed for the treatment of macular holes between 1998 -2004 in our health care centre. Methods: A retrospective, comparative, and nonrandomized study of 131 eyes with macular holes, stage III and IV, treated with three different surgical techniques was performed. Vitrectomy was performed in 25 eyes (group 1). Vitrectomy was associated with internal limiting membrane peeling in 19 eyes (group 2), and in the remaining 87 eyes, the peeling of the retinal internal limiting membrane was assisted with indocyanine green (ICG) (group 3). The concentrations of ICG used were 5%, 2.5% and 0.5%. We compared the anatomic and functional results, and the complications which occurred. Results: The overall anatomic success rate was 88.4% (114 eyes), and it was higher in group 3 (90.6%). A visual acuity improvement was achieved in 63.6% of eyes; however there were no significant differences between the groups studied. The most important complications included cataracts (51.9%), increase in intra-ocular pressure (37.2%), retinal detachment (7.8%) and retinal pigment epithelial changes (7%). These pigment epithelial changes were associated with the use of ICG-assisted peeling (p<0.05), but there was no correlation between the changes and the concentration of ICG employed. The hole size had an inverse correlation with initial and final visual acuity. An epi-retinal membrane was associated with better visual acuities and higher anatomic success. Conclusions: In our experience, the use of ICGassisted internal limiting membrane peeling in macular hole surgery improves the anatomic success, but may lead to retinal pigment epithelial change (AU)