Long-term results of intravitreal bevacizumab and dexamethasone for the treatment of punctate inner choroidopathy associated with choroidal neovascularization: A case series

Abstract

Introduction:To present a case series of three female patients with punctate inner choroidopathy. We report the outcomes after an essentially long follow-up period of up to 14 years and provide evidence of the effectiveness of intravitreal injections of bevacizumab and dexamethasone 0.7 mg in punctate inner choroidopathy patients with choroidal neovascular membrane formation.Case series presentation:This is a retrospective case series of three female patients with punctate inner choroidopathy who were treated with intravitreal injections anti-vascular endothelial growth factor agent (bevacizumab, 1.25 mg/0.05 mL). Two patients also received intravitreal dexamethasone 0.7 mg. Once a choroidal neovascular membrane developed, the outcome was poor with a best-corrected visual acuity of 6/60 or counting fingers in the affected eyes. The patients were followed up for 5, 14 and 8 years.Conclusion:The use of dexamethasone 0.7 mg in punctate inner choroidopathy yielded encouraging results and long periods of stability. When choroidal neovascular membrane complicates the primary disease, the prognosis is unfavourable, especially if the macula integrity has already been considerably affected. On the contrary, aggressive early therapy and continued monthly monitoring can prevent severe fibrosis, as showed in previous reports. Further larger-scale studies are needed to evaluate the efficacy of intravitreal dexamethasone 0.7 mg and bevacizumab as an alternative treatment in non-infectious uveitis.

Treatment of Punctate Inner Choroidopathy with Choroidal Neovascularization Using Corticosteroid and Intravitreal Ranibizumab

“…However, these results were not statistically significant, and the retrospective, nonrandomized nature of this study means we cannot exclude the effect of biases and confounders. Consistent with our findings, previous small-scale case series (less than 3 patients) have reported that combining corticosteroid and anti-VEGF therapy should be considered as a management of CNV associated with PIC [ 24 , 25 ]. In addition to corticosteroids, immunosuppressants have also been proposed for control of inflammatory CNV [ 26 ].…”

Clinical Study of Intravitreal Injection of Anti-VEGF Drugs Combined with Triamcinolone Acetonide in the Treatment of Coats Disease

“…This study investigated the clinical efficacy of intravitreal trimethoprim in patients with Gauss' disease and showed improvements in visual acuity and central retinal thickness [15]. Trimethoprim counteracts fibroblast growth factor-(bFGF-) induced proliferation of capillary endothelial cells, thereby inhibiting the formation of neovascular membranes [16]. It has a long half-life in the eye, and some studies have shown that intravitreal tretinoin maintains a certain concentration in the eye after four months of intravitreal injection [17].…”

Manejo da coroidite interna punctata complicada por membrana neovascular sub-retiniana

“…(1) As modalidades terapêuticas para MNVC relacionada à PIC não estão bem estabelecidas, mas os regimes de tratamento relatados incluem fotocoagulação a laser, tratamento fotodinâmico e injeções intravítreas de antifator de crescimento endotelial vascular (VEGF). (2,3) As abordagens terapêuticas para PIC são feitas com esteroides sistêmicos, tópicos e perioculares, além de agentes imunomoduladores poupadores de corticoide. No OD, a AF demonstrou hiperfluorescência precoce no subepitélio pigmentar da retina com pooling e hipofluorescência por bloqueio e, no OE, hiperfluorescência em todas as fases relacionadas às cicatrizes coroidais (Figura 3).…”