Stargardt's pigmentosa: A novel combination of two inherited retinal dystrophies.

60-year-old woman referring visual disability. She presented bone spicule pigmentation and retinal atrophy in all peripheral retina, as well as macular retinal flecks. Multimodal imaging showed typical findings of both inherited retinal dystrophies (IRD). Electroretinogram confirmed rod dysfunction. Biallelic mutations were found in ABCA4 and CNGA1 genes. Although not common, different IRDs may be present in a same patient at the same time. This is the first reported case of the combination of RP with late-onset Stargardt's disease. We propose the name 'Stargardt's pigmentosa' for this novel clinical entity.

Relación entre grosor coroideo y densidad vascular en población joven sana / Relationship between choroidal thickness and vascular density in young healthy population

Antecedentes y objetivo El objetivo es analizar la densidad vascular (DV) coroidea en individuos sanos y compararla con el grosor coroideo (GC). Materiales y métodos Estudio transversal incluyendo individuos entre 18 y 35 años, caucásicos y con longitud axial (LA) 21-26 mm. Se estudió la coroides con tomografía de coherencia óptica-angiografía (OCTA) Triton DRI (Topcon) y se obtuvo un cubo macular de 6x6 mm. El software dio los valores de GC automáticamente. Los valores de DV se obtuvieron mediante codificación en números de los colores de los mapas de DV. Resultados Se analizaron 102 ojos (51 pacientes). La edad media fue 27,32 ± 3,94 años, la presión intraocular media fue 18,07 ± 2,38 mmHg, y la LA media fue 23,71 ± 0,66 mm. El GC fue mayor en el eje vertical y menor al acercarse a los lados nasal y temporal. El mayor GC se encontró en la mácula superior. La mayor DV coroidea fue en la fóvea y en la región yuxtapapilar. La menor DV coroidea se halló en la mácula superior e inferior. Se encontraron correlaciones moderadas inversas entre GC y DV coroidea en las regiones yuxtapapilar e inferior. Conclusiones La coroides tiene un patrón de grosor diferente del de la retina. Los vasos coroideos representan un porcentaje muy alto de la coroides en las regiones peripapilar y fóvea. Por el contrario, la mácula superior e inferior muestra valores bajos de DV (AU)

Background and purpose The purpose is to analyze choroidal vascular density (VD) in healthy individuals and to compare it with choroidal thickness (CT). Materials and methods Cross-sectional study enrolling healthy individuals between 18 and 35 years old of Caucasian race and with an axial length (AL) 21–26 mm. Choroid was imaged with swept-source optical coherence tomography angiography (OCTA) Triton DRI (Topcon) and a macular cube of 6 mm × 6 mm was obtained. CT values were automatically given by the software. VD values were obtained through codifying colors of the VD map into numbers. Results One hundred and two (51 patients) were analyzed. Mean age was 27.32 ± 3.94 years old, mean intraocular pressure was 18.07 ± 2.38 mmHg, and mean AL was 23.71 ± 0.66 mm. CT was higher in the vertical axis and lower when approaching nasal and temporal sides. The highest CT was in superior macula. The highest choroidal VD were in the fovea and in the juxtapapillary region. The lowest choroidal VD were found in superior and inferior macular areas. Moderate inverse correlations between CT and choroidal VD were found in the juxtapapillary and inferior regions. Conclusions The choroid has a thickness pattern that differs from retina. Choroidal vessels represent a very high percentage of choroid in the peripapillary region and in the fovea. On the contrary, superior and inferior macula reveals low values of VD (AU)

Relationship between choroidal thickness and vascular density in young healthy population.

BACKGROUND AND PURPOSE: The purpose is to analyze choroidal vascular density (VD) in healthy individuals and to compare it with choroidal thickness (CT). MATERIALS AND METHODS: Cross-sectional study enrolling healthy individuals between 18 and 35 years old of Caucasian race and with an axial length (AL) 21-26 mm. Choroid was imaged with swept-source optical coherence tomography angiography (OCTA) Triton DRI (Topcon) and a macular cube of 6 × 6 mm was obtained. CT values were automatically given by the software. VD values were obtained through codifying colors of the VD map into numbers. RESULTS: 102 (51 patients) were analyzed. Mean age was 27.32 ±â€¯3.94 years old, mean intraocular pressure was 18.07 ±â€¯2.38 mmHg, and mean AL was 23.71 ±â€¯0.66 mm. CT was higher in the vertical axis and lower when approaching nasal and temporal sides. The highest CT was in superior macula. The highest choroidal VD were in the fovea and in the juxtapapillary region. The lowest choroidal VD were found in superior and inferior macular areas. Moderate inverse correlations between CT and choroidal VD were found in the juxtapapillary and inferior regions. CONCLUSIONS: The choroid has a thickness pattern that differs from retina. Choroidal vessels represent a very high percentage of choroid in the peripapillary region and in the fovea. On the contrary, superior and inferior macula reveals low values of VD.

Retinosis pigmentaria sine pigmento. Inicio con edema macular / Retinitis pigmentosa sine pigmenti. Debut with macular oedema

CASO CLÍNICO: Mujer de 25 años que presenta metamorfopsia y disminución de agudeza visual en ojo izquierdo de un año de evolución. A la exploración se aprecia un edema macular quístico (EMQ) y atenuación vascular bilateral. Se describen las pruebas diagnósticas, así como el diagnóstico diferencial y la respuesta al tratamiento con inhibidores de anhidrasa carbónica. DISCUSIÓN: La retinosis pigmentaria sine pigmento es un subtipo de retinosis pigmentaria atípica, caracterizada por la ausencia de depósitos pigmentarios. La hemeralopía es más leve y la afectación campimétrica y electrorretinográfica es menor. El EMQ constituye una causa importante de pérdida de visión central, y responde al tratamiento con inhibidores de anhidrasa carbónica

CASE REPORT: A 25-year-old woman, with metamorphopsia in her left eye of one year onset. The examination revealed a bilateral cystoid macular oedema (CME) and vascular attenuation. We describe the diagnostic tests, as well as differential diagnosis and treatment response with carbonic anhydrase inhibitors. DISCUSSION: The retinitis pigmentosa sine pigment is a subtype of atypical retinitis pigmentosa characterised by the absence of pigment deposits. The night blindness is milder, and perimetric and electroretinographic impairment is lower. CME is an important cause of central vision loss, and responds to anhydrase carbonic inhibitors

Retinitis pigmentosa sine pigmenti. Debut with macular oedema.

CASE REPORT: A 25-year-old woman, with metamorphopsia in her left eye of one year onset. The examination revealed a bilateral cystoid macular oedema (CME) and vascular attenuation. We describe the diagnostic tests, as well as differential diagnosis and treatment response with carbonic anhydrase inhibitors. DISCUSSION: The retinitis pigmentosa sine pigment is a subtype of atypical retinitis pigmentosa characterised by the absence of pigment deposits. The night blindness is milder, and perimetric and electroretinographic impairment is lower. CME is an important cause of central vision loss, and responds to anhydrase carbonic inhibitors.

Use of a new ocular insert versus conventional mydriasis in cataract surgery.

BACKGROUND: To compare the efficacy and safety of a new ocular insert versus conventional mydriasis in cataract surgery. METHODS: We selected 70 patients undergoing cataract surgery. Thirty five patients (Group 1) received instillation of mydriatic drops (tropicamide 1%, phenylephrine 10%, and cyclopentolate 1%) prior to surgery, and 35 patients (Group 2) had a Mydriasert insert (Théa Pharma) (0.28 mg of tropicamide and 5.4 mg of phenylephrine hydrochloride) placed in the inferior fornix. Pupil size before and after surgery, blood pressure, and heart rate were measured. RESULTS: Before surgery, pupil diameter was 9.44 ± 1.17 mm in Group 1 and 9.05 ± 1.54 in Group 2 (P > 0.05). Twenty four hours after surgery, pupil diameter was 5.20 ± 1.54 mm in Group 1 and 3.33 ± 1.15 in Group 2 (P < 0.001). There were no statistically significant differences in blood pressure or heart rate between groups. CONCLUSIONS: The effect of the Mydriasert insert was similar to conventional mydriatic agents. Pupil size was restored to normal faster when using the Mydriasert insert compared with conventional mydriatic agents for pupil dilation.

Bilateral choroidal metastases as presentation of dissemination of cutaneous malignant melanoma.

Case Report. A 47-year-old man presented with blurred vision in the right eye. Ophthalmoscopic examination showed several placoid, pigmented lesions in the posterior pole and midperiphery of the retina of both eyes. Results. Patient referred a cutaneous malignant melanoma on the back skin removed 6 years ago. A systemic workup revealed multiple metastases in liver and spleen. After an exhaustive study we concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases. The patient obtained clinical ocular improvement after palliative chemotherapy, although he died in the following months. Pathological examination of the lesions confirmed the diagnosis of choroidal metastases from a malignant cutaneous melanoma. Conclusions. Monitoring patients who have had cutaneous malignant melanoma is very important, since melanoma metastases may occur even many years after the diagnosis of the primary tumor. Choroidal metastases from cutaneous melanoma are uncommon but we should be aware because their appearance worsens prognosis.

[Intravitreal ranibizumab for choroidal neovascularisation associated with adult-onset vitelliform dystrophy]. / Ranibizumab intravítreo en neovascularización coroidea secundaria a distrofia foveomacular viteliforme del adulto.

CASE REPORT: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion. DISCUSSION: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation.

Ranibizumab intravítreo en neovascularización coroidea secundaria a distrofia foveomacular viteliforme del adulto / Intravitreal ranibizumab for choroidal neovascularisation associated with adult-onset vitelliform dystrophy

Caso clínico: Varón de 70 años diagnosticado de distrofia foveomacular viteliforme del adulto(DFVA) que en el curso de su enfermedad presenta disminución brusca de visión en el ojo izquierdo coincidiendo con la aparición de una membrana neovascular oculta. Dada la localización yuxtafove al de la membrana, se decidió tratar con ranibizumab intravítreo, siendo necesarias 2 inyecciones para lograr el cierre completo de la lesión neovascular. Discusión: El uso de ranibizumab intravítreo puede ser una opción de tratamiento eficaz en la neovascularización coroidea secundaria a DFVA, y se precisan series de casos más amplias para poder confirmar esta observación(AU)

Case report: A 70-year-old male patient diagnosed with bilateral adult-onset vitelliform dystrophy presented with a sudden decrease of vision in his left eye associated with the appearance of an occult type of neovascular membrane. It was treated with intravitreal ranibizumab due to juxtafoveal location of the membrane. Two injections were needed to induce total regression of the lesion. Discussion: Intravitreal ranibizumab may be effective to induce morphological and functional improvement in cases of choroidal neovascularization secondary to adult-onset vitelliform foveomacular dystrophy. Further case series are required to confirm this observation(AU)

[Retinal angiomatous proliferation not associated with age-related macular degeneration. Favourable outcome after photodynamic therapy]. / Proliferación angiomatosa retiniana no relacionada con degeneración macular asociada a la edad. Buena respuesta al tratamiento con terapia fotodinámica.

CASE: A 55-year-old male was diagnosed with exudative-hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome. DISCUSSION: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD

Proliferación angiomatosa retiniana no relacionada con degeneración macular asociada a la edad. Buena respuesta al tratamiento con terapia fotodinámica / Retinal angiomatous proliferation not associated with age-related macular degeneration. Favourable outcome after photodynamic therapy

Caso clínico: Varón de 55 años, sin drusas ni alteraciones del epitelio pigmentario sugestivas de degeneración macular asociada a la edad (DMAE), que presentó maculopatía exudativo-hemorrágica. La angiografía con fluoresceína e indocianina verde mostraron la proliferación angiomatosa retiniana (PAR), la arteriola aferente y vénula retinianas de drenaje. La respuesta fue óptima a un único tratamiento con terapia fotodinámica. Discusión: La PAR es una lesión descrita en los últimos años en el contexto de la DMAE, cuya principal característica es la lesión neovascular formada a partir de capilares retinianos y su extensión posterior al espacio subretiniano. Nuestro paciente presentaba los hallazgos típicos de PAR sin DMAE

Case: A 55-year-old male was diagnosed with exudative- hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome. Discussion: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD

[Optical coherence tomography of retinal pigment epithelial tears]. / Optical coherence tomography en desgarro del epitelio pigmentario retiniano.

CASE REPORTS: Three cases of pigmentary epithelial tears are described in this study. One of them was related to previous extrafoveal photocoagulation, whereas the other two were idiopathic. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed to confirm the clinical diagnosis. DISCUSSION: Few studies using OCT to assess pigmentary retinal epithelial (RPE) tears have been published in the world literature. The main findings of our study included hyper-reflectant line breaks, choroidal hyper-reflectance due to the lack of RPE and RPE double layering where it was folded. Images were frequently associated with RPE tears and neurosensorial retinal detachment.

«Optical Coherence Tomography» en desgarro del epitelio pigmentario retiniano / «Optical Coherence Tomography» of retinal pigment epithelial tears

Casos clínicos: Se presentan 3 pacientes con desgarro de epitelio pigmentario retiniano (EPR). En dos de ellos, éste se produjo de manera espontánea, estando el tercero en relación con la fotocoagulación de una neovascularización extrafoveal. Se realizaron angiografías (AGF) y estudio con tomografia óptica de coherencia (OCT) que confirmaron el diagnóstico. Discusión: Existen pocos estudios sobre OCT en desgarro del EPR. Las principales características son: interrupción de la línea hiperreflectante del EPR, hiperreflectividad de la coroides en la zona de ausencia de EPR y doble capa de EPR donde éste está replegado. Es frecuente el desprendimiento de EPR y neurosensorial asociado

Case reports: Three cases of pigmentary epithelial tears are described in this study. One of them was related to previous extrafoveal photocoagulation, whereas the other two were idiopathic. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed to confirm the clinical diagnosis. Discussion: Few studies using OCT to assess pigmentary retinal epithelial (RPE) tears have been published in the world literature. The main findings of our study included hyper-reflectant line breaks, choroidal hyper-reflectance due to the lack of RPE and RPE double layering where it was folded. Images were frequently associated with RPE tears and neurosensorial retinal detachment

[Pseudophakic cystoid macular edema. Assessment with optical coherence tomography]. / Edema macular quístico pseudofáquico. Detección mediante "optical coherence tomography".

PURPOSE: To determine the incidence of cystoid macular edema (CME) by means of clinical evaluation and subclinical assessment by means of ocular coherence tomography (OCT), and to compare the incidence between diabetic and non-diabetic groups of patients. METHODS: Prospective study of 260 consecutive cataract surgeries operated from September 2004 to March 2005. The procedures were performed by means of phacoemulsification plus intraocular acrylic lens implantation. Group A: 208 eyes of non-diabetic patients; Group B: 42 eyes of patients with diabetes and Group C: 10 eyes of diabetic patients with macular edema that received an intravitreal injection of triamcinolone at the end of surgery. Postoperative follow-up visits were performed 6 days (basal visit), 5 weeks and 12 weeks after surgery. Each visit included posterior pole biomicroscopy and OCT. RESULTS: Central macular thickness measured by OCT was significantly increased in group B compared with group A (241.6 versus 204.6 microm; p<0.001). No clinical evidence of CME was found in group A, although 4 eyes (1.92%) showed macular thickness equal to or greater than 43.74 microm (2 standard deviations of the basal value for group A). In group B, clinical evidence of CME was found in 6 eyes, with decreased visual acuities (14.2%). The differences between these groups were statistically significant (p<0.001). The 10 eyes that received an intravitreal injection of triamcinolone after the surgical procedure showed a mean decrease in central retinal thickness of 77 microm after 12 weeks postoperative. CONCLUSIONS: This study has shown a low incidence of clinical CME. OCT showed increased macular thickness in both groups of patients in a small percentage of cases, and significantly increased macular thickness in diabetic patients.

Edema macular quístico pseudofáquico. Detección mediante «Optical Coherence Tomography» / Pseudophakic cystoid macular edema. Assesment with optical coherence tomography

Objetivo: Detectar la incidencia de edema macularquístico (EMQ) tras cirugía de catarata tanto clínicocomo subclínico, mediante «ocular coherencetomography» (OCT) y comparar dicha incidenciaentre un grupo de pacientes diabéticos y otro de nodiabéticos.Material y métodos: Estudio prospectivo de 260ojos intervenidos de forma consecutiva de cataratamediante facoemulsificación con implante de lenteintraocular acrílica, desde septiembre de 2004 amarzo de 2005. Grupo A: 208 ojos de pacientes nodiabéticos, grupo B: 42 ojos de pacientes diabéticos,grupo C: 10 ojos de pacientes diabéticos conedema macular y que recibieron triamcinolonaintravítrea (TAIV) al finalizar la cirugía. En cadarevisión efectuada a los 6 días (basal), 5 semanas y12 semanas se realizó biomicroscopía de polo posteriory OCT.Resultados: El espesor macular en la OCT, fue significativamentesuperior en el grupo B que en elgrupo A (241,6 versus 204,6 μm p=43,74 μm (2 DE del valor basal del grupo A). En elgrupo B, seis ojos presentaron EMQ clínicamentesignificativo, con disminución de agudeza visual(14,2%), en 12 ojos detectamos aumento del espesormacular (28,5%). Las diferencias entre gruposfueron significativas (p<0,001). En los 10 ojos querecibieron TAIV se observó una disminución mediadel espesor central de 77 μm a las 12 semanas.Conclusiones: La incidencia de EMQ clínico hasido muy baja en esta serie. La OCT detectó unaumento del espesor macular en ambos grupos enun pequeño porcentaje de pacientes y significativamentemayor en el grupo de pacientes diabéticos

Purpose: To determine the incidence of cystoid macular edema (CME) by means of clinical evaluation and subclinical assessment by means of ocular coherence tomography (OCT), and to compare the incidence between diabetic and non-diabetic groups of patients. Methods: Prospective study of 260 consecutive cataract surgeries operated from September 2004 to March 2005. The procedures were performed by means of phacoemulsification plus intraocular acrylic lens implantation. Group A: 208 eyes of nondiabetic patients; Group B: 42 eyes of patients with diabetes and Group C: 10 eyes of diabetic patients with macular edema that received an intravitreal injection of triamcinolone at the end of surgery. Postoperative follow-up visits were performed 6 days (basal visit), 5 weeks and 12 weeks after surgery. Each visit included posterior pole biomicroscopy and OCT. Results: Central macular thickness measured by OCT was significantly increased in group B compared with group A (241.6 versus 204.6 μm; p<0,001). No clinical evidence of CME was found in group A, although 4 eyes (1.92%) showed macular thickness equal to or greater than 43.74 μm (2 standard deviations of the basal value for group A). In group B, clinical evidence of CME was found in 6 eyes, with decreased visual acuities (14.2%). The differences between these groups were statistically significant (p<0.001). The 10 eyes that received an intravitreal injection of triamcinolone after the surgical procedure showed a mean decrease in central retinal thickness of 77 μm after 12 weeks postoperative. Conclusions: This study has shown a low incidence of clinical CME. OCT showed increased macular thickness in both groups of patients in a small percentage of cases, and significantly increased macular thickness in diabetic patients

Grepafloxacin concentration in ocular tissues after intravenous infusion in rabbits with intraocular inflammation.

PURPOSE: To determine the penetration of grepafloxacin into ocular tissues during experimental ocular inflammation. METHODS: 10 albino and 10 pigmented rabbits underwent a continuous intravenous infusion of the drug 24 h after injecting Salmonella typhimurium toxin intravitreously, creating ocular inflammation. The animals were killed and grepafloxacin levels were determined in plasma and ocular tissues using high performance liquid chromatography. RESULTS: Grepafloxacin levels achieved a steady-state plasma concentration of 1.5 microg/ml. The drug diffused more towards vascularized tissues (chorioretina and iris) in both albino and pigmented rabbits with a tissue/serum ratio higher than 1. Grepafloxacin showed more affinity to pigmented tissue, rising levels of 40,000-50,000 ng/g in the chorioretina and iris in pigmented animals. After inflammation, grepafloxacin intraocular penetration increased in albino animals with levels exceeding the minimum inhibitory concentration for the most common ocular pathogens. CONCLUSION: Grepafloxacin intraocular penetration is higher in pigmented tissues. Ocular inflammation increases the drug penetration into the vitreous.

Terapia fotodinámica en neovascularización coroidea / Photodynamic therapy for treatment of choroidal neovaoscularization

Objetivo: Valorar la eficacia de la terapia fotodinámica (TFD) en el tratamiento de neovascularización subretiniana (NVSR) causada por DMAE (degeneración macular asociada a la edad) y miopía. Material y método: Se estudiaron 102 pacientes con neovascularización coroidea yuxta o subfoveolar tratados con TFD en los que se valoró: Agudeza visual (AV), examen oftalmoscópico y angiografía fluoresceínica. El retratamiento se realizó cuando fue necesario cada tres meses. Resultados: La etiología de la neovascularización coroidea fue: 75,5% por DMAE y 24,5% miópica. El tiempo de seguimiento medio fue de 15,94 meses (9-33). Un 88% de las NVSR eran angiográficamente clásicas en los miopes y un 40% en las DMAE. La supervivencia de la membrana resultó significativa en función del tipo de NVSR, presentando una mejor evolución en los pacientes miopes (p=0,0018). La AV mejoró en 48% de los pacientes miopes y en 28,6% de las DMAE. No se objetivaron complicaciones severas atribuibles al tratamiento. Conclusiones: La TFD es un tratamiento moderadamente efectivo y sin complicaciones para el tratamiento de la NVSR sub/yuxta foveolar(AU)

Purpose: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia. Methods: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months. Results: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT. Conclusion: PDT is a moderately effective treatment without complications in treating subfoveal CNV(AU)

[Idiopathic polypoidal choroidal vasculopathy]. / Vasculopatía coroidea polipoidal idiopática.

PURPOSE: To evaluate the incidence, clinical features and evolution of polypoidal choroidal vasculopathy (PCV) in our population. METHODS: Retrospective study of patients diagnosed with exudative and/or hemorrhagic maculopathy including age-related macular degeneration in the last two years and who have undergone a complete ophthalmologic exploration and videoangiography with fluorescein and indocyanine green. RESULTS: 250 patients were included in the study, 8 patients (3.2%) had clinical and angiographic criteria of PCV. The mean age was 68 years-old, 62.5% were men and 85.7% were caucasian. Ninety percent of cases presented clinically as a predominantly hemorrhagic macular detachment. The initial clinical diagnosis before indocyanine green angiography was exudative age-related macular degeneration in 90% of cases. The mean visual acuity was 0.2 at baseline and after follow-up. Laser treatment was performed in 4 eyes, achieving good anatomic and visual acuity results in 2 of them; both eyes of one patient were treated by photodynamic therapy with poor angiographic and functional outcome. CONCLUSIONS: Polypoidal choroidal vasculopathy is a clinical entity which is relatively frequent among patients previously diagnosed with exudative maculopathy. Indocyanine green angiography increases the number of correct diagnoses. Treatment must be individualized depending on the location of the lesions and the severity of the disease.

[Serpiginous choroiditis: clinical course and treatment]. / Coroiditis serpiginosa: evolución clínica y tratamiento.

PURPOSE: To evaluate the clinical evolution and treatment of serpiginous choroiditis in 11 diagnosed patients. METHODS: Retrospective study of 11 cases diagnosed with serpiginous choroiditis in our area, from 1980 to the present. We analyzed age at onset of symptoms, systemic diseases, ophthalmological symptoms at presentation, the location of lesions, initial and final visual acuity, recurrences, treatment régime and development of subretinal neovascularization. A complete ophthalmological examination and fluorescein angiograms were performed in all of them. RESULTS: The mean period of follow-up was 4 years. Average age was 56 years, predominantly in men (10/1). Five patients had known ischemic cardiopathy and systemic hypertension, one patient underwent a kidney transplant. All of them were treated with oral prednisone (1-1.5 mg/kg/daily) in the active stages. Three patients received triple therapy (prednisone, cyclosporine and azathioprine) that did not prevent the recurrences. Five patients developed a subretinal neovascularization, bilateral in three of them. CONCLUSIONS: The serpiginous choroiditis is a rare entity and the visual outcome prognosis is determined by the macular involvement. Men are predominantly affected in our series and corticosteroid treatment is effective in acute inflammatory episodes. Recurrences could not be prevented by triple therapy with immunosuppressive agents in our three patients.