Objective: This study aimed to analyze the variation in subfoveal choroidal thickness (SFCT) and its relationship with the variation in central macular thickness (CME) in response to intravitreal therapy with an antiangiogenic (anti-VEGF) drug or corticosteroid in type 2 diabetic patients with diabetic macular edema (DME). Material and methods: This retrospective study included 70 eyes of 35 patients: 26 eyes received 4−5 intravitreal injections of aflibercept, 26 eyes were treated with a single intravitreal implant injection of dexamethasone, and 18 eyes without DME did not receive intravitreal therapy. SPECTRALIS® optical coherence tomography (OCT) (Heidelberg Engineering, Heidelberg, Germany) was used to measure the SFCT and CME before and at the end of the follow-up period. Results: The mean reductions in CME were 18.8 +/− 14.7% (aflibercept) and 29.7 +/− 16.9% (dexamethasone). The mean reductions in SFCT were 13.8 +/− 13.1% (aflibercept) and 19.5 +/− 9.6% (dexamethasone). The lowering effects of both parameters were significantly greater in the group treated with the dexamethasone implant (p = 0.022 and p = 0.046 for CMT and SFCT, respectively). Both therapies significantly decreased both CME and SFCT, independent of factors such as age, sex, previous intravitreal therapy, antidiabetic treatment, and the time of diabetes progression. There were no changes in the mean values of CME and SFCT in the untreated eyes. Conclusions: SFCT significantly decreased in response to intravitreal therapy with anti-VEGF or corticosteroids, irrespective of age, sex, previous intravitreal therapy, antidiabetic treatment, and the time of diabetes progression. There was a correlation between the changes in CME and SFCT after intravitreal therapy with aflibercept or dexamethasone implantation. SFCT was not a good predictor of the CME response but could be used to monitor the response to treatment. Local intravitreal therapy only affected the treated eye.
RESUMENCaso clínico: Varón de 35 años con antecedentes familiares de enfermedad de von Hippel-Lindau (VHL) diagnosticado de dos hemangiomas retinianos en ojo derecho (OD) y uno en ojo izquierdo. Las lesiones se trataron con crioterapia en OD y láserterapia en OI. A pesar de una aparente buena evolución de las lesiones retinianas hubo una progresiva disminución de la AV. Se realizó RM donde se evidenció lesiones tumorales del nervio óptico (NO) bilaterales compatibles con glioma, meningioma o hemangioblastoma. Actualmente: AV (OD): movimiento de manos y AV(OI): 0,6. Discusión: La presencia de los hemangiomas retinianos en este paciente hizo retrasar el diagnóstico de un tumor en el NO, infrecuente en esta entidad.Palabras clave: Enfermedad de von Hippel-Lindau, hemangioma retiniano, tumor del nervio ópti-co, hemangioblastoma del nervio óptico.
COMUNICACIÓN CORTA
ABSTRACTClinical case: A 35-year-old man with a family history of von Hippel-Lindau disease was diagnosed to have two retinal hemangiomas in the right eye and another in the left eye. The hemangiomas were treated with cryotherapy and laser photocoagulation respectively. Despite apparent good resolution of the retinal lesions, progressive visual loss was observed. An MRI was then performed and showed bilateral tumoral lesions of the optic nerve compatible with a glioma, meningioma or hemangioblastoma. Currently the visual acuity in his right eye is hand movement, and is 0.6 in the left eye. Discussion: The presence of the retinal hemangiomas delayed the diagnosis of an optic nerve tumor in this patient (Arch Soc Esp Oftalmol 2006; 81: 293-296).
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