First Author: A.Neves PORTUGAL
Co Author(s): A. Campos J. Campos S. Mendes L. Violante J.P.C. Sousa 0 0 0 0 0 0 0 0 0
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To report the evolution of two cases of subretinal fluid resistant to anti-VEGF treatment that had a good response to photodynamic therapy (PDT), after a diagnosis of polypoidal choroidal vasculopathy (PCV) with ICG.
Ophthalmology Department, Santo André Hospital, Leiria Hospital Center, Portugal.
Retrospective descriptive study of two clinical cases primarily diagnosed to have exudative age-related macular degeneration (AMD) in one case and branch retinal vein occlusion (BRVO) in the other case, based on information from patient observation, clinical records and analysis of complimentary diagnostic tests. Patients were first treated with intravitreal injections of anti-VEGF. After performing ICG, PCV was diagnosed and PDT was performed in both cases.
One eye of one patient was diagnosed as havig AMD and received 3 monthly injections of Ranibizumab and another eye of a second patient was diagnosed as having BRVO and received 5 monthly injections of Ranibizumab. After treatment, optical coherence tomography (OCT) revealed serous pigment epithelial detachment (SPED) and no improvement in retinal thickness. There was no improvement in the best corrected visual acuity (BCVA). After ICG, the diagnosis of PCV was established in both cases. PDT was performed, and there was improvement in BCVA in the two cases: from 46 to 55 ETDRS letters in the eye of the first patient, and from 58 to 69 ETDRS letters in the second one. OCT revealed resolution of SPED and decrease of central macular thickness (CMT).
Resistance to anti-VEGF therapy may be due to several factors. The ICG plays an important role in such cases, because it provides important clues to establish a correct diagnosis and is necessary to the diagnosis of PCV. That will lead to a change in treatment from anti-VEGF agents to PDT, which carries a better prognosis for the patient.