First Author: A.González-Gómez SPAIN
Co Author(s): M.J. Morillo Sánchez A.M. Soler García 0 0 0 0 0 0 0 0 0
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To study the response to treatment with intravitreal injections of Ranibizumab in Choroidal neovascularization (CNV) secondary to Pseudoxanthoma Elasticum (PXE).
Virgen de la Victoria Hospital. Málaga.
We report a case of 52 years female who presented decreased visual acuity (VA) in her left eye (LE): 0,5. An ophthalmic examination was performed including funduscopy, fluorescein angiography (FAG) and optical coherente tomography (OCT). The diagnosis was CNV secondary to PXE. We prescribed treatment with monthly intravitreal injections of 0.05 ml of ranibizumab (Lucentis) with a loading phase with three injections followed by “pro re nata” (PRN). It was monitorized by VA and OCT each month during 40 months. Re-treatment criteria were: VA decreased in the presence of macular fluid, new macular haemorrhage or persistent macular fluid on OCT.
VA improved to 0.7 after loading phase, and the injury is inactivated. At 10 months VA decreased to 0.5, and macular fluid was detected by OCT. WE reinjected with a dose of 0.5 ml of ranibizumab achieving inactivity for 14 months, in which macular fluid appeared again and VA loss. After a new reinjection VA at 0,7 was achieved and there were not signs of activity. At the present day NVC is stable (40 months).
NVC affects 50-70% of patients with PXE. Laser photocoagulation has been useful for extra or juxtafoveal location, it can assist in the closure and stabilization of vision. Photodynamic therapy does not alter the course, it only slows progression by decreasing exudation. There have been cases of CNV secondary to PXE treated with bevacizumab (Avastin). Bhatnagar et al. studied 9 cases of CNV secondary to PXE, treated with on average of 1.8 intravitreal injections of Avastin and followed up for 6 months and showed visual stabilization in 100% of cases, and decreased average thickness macular measured by OCT. Recent studies of Ioannis et al. and Vadala et al. showed similar results with injections of Ranibizumab but found recurrences in 70% of cases. Five injections of ranibizumab were necessary in 40 months for our patient, finding good response to treatment and two recurrences.