First Author: E.Rodriguez-Neila SPAIN
Co Author(s): C. Villace
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We report the successful treatment by low-fluence verteporfine photodynamic therapy (PDT) of two male patients with chronic exudative macular detachment associated with tilted disc syndrome (TDS).
TDS can include serous retinal detachment, caused by subretinal leakage that mimics chronic idiopathic central serous chorioretinopathy (ICSC). Vision loss may accompany sub-macular fluid accumulation, for which no effective treatment has been reported.
Two patients aged 53 and 28 with macular detachment documented by optical coherence tomography (OCT) received half-fluence verteporfin photodynamic therapy guided by angiography. One or more laser spots were applied to the areas of choroidal vascular hyperpermeability. Patients were observed for 6 to 12 months. Examinations included visual acuity measurement, fundus biomicroscopy, fluorescein angiography and OCT.
Visual acuity decrese was present for months. Subretinal fluid was observed by OCT. Our two cases presented areas of choroidal vascular hyperpermeability, areas of leakage in the Retinal Pigment Epithelium (RPE) and RPE descompensation. Both cases were refractory to several treatments including intravitreal anti-VEGF injections in one eye and oral spironolactone. After a single session of half-fluence verteporfin photodynamic therapy, the submacular fluid resolved completely in each case.
We hypothesize that choriocapillary and pigment epithelial disturbances permit the subretinal leakage in tilted disc syndrome. The pathogenesis of this leakage remains unclear. This entity has to be differentiated from a chronic form of ICSC. Low-fluence PDT should be considered as treatment in cases of foveal detachment associated to TDS.