Purpose: the aim of the present study is to report on the results obtained in a pilot study with a combined treatment of half-fluence half-dose photodynamic therapy (PDT) and subthreshold 577 nm micropulse laser treatment (STLT) for SRD(sub retinal detachment) related to DSM(dome shaped macula) poorly responsive to previous LIGHT-PDT: Efficacy and Safety. Methods : 11 Patients (8 females and 3 males) referred to the Department of Ophthalmology of University Politecnica delle Marche with the diagnosis of symptomatic DSM were prospectively enrolled in the study. Inclusion criteria included the diagnosis of symptomatic DSM, associated with SRD; DSM was regarded as symptomatic whenever associated with visual acuity deterioration and distortion. DSM definition was based on the OCT identification of an inward bulge inside the chorioretinal posterior concavity of the macular area, according to Gaucher’s description. Patients who had undergone any previous treatment in the last 3 months or were affected by any other ocular disease were excluded from the study.Each patient underwent a complete ophthalmologic examination, including best-corrected visual acuity(BCVA) on standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts, blue-light fundus autofluorescence, fluorescein angiography ( FA), indocyanine green angiography (ICGA), OCT and OCT Angiography (OCTA). The patients were regularly scheduled. Each patient was first treated with half-fluence half-dose photodynamic therapy; after two weeks subthreshold 577 nm micropulse laser treatment was performed. Results :Overall, 11 eyes of 11 patients were included in the study. Subfoveal choroidal thickness was 183μm(SD 75.41μm ) and mean Central foveal thickness was 271.8μm (SD 64.19μm) to the last follow-up.Half-fluence half-dose photodynamic therapy and subthreshold micropulse laser treatment were uneventfully performed in all the cases, and were addressed to the ICGA- detected hyperfluorescent area. Serous retinal detachment diminished in all cases, and 5 eyes registered complete resolution at the end of the 6 month follow-up. No case showed enlargement of atrophic alterations, as assessed on blue-light fundus autofluorescence, or development of choroidal neovascularization at the end of the follow-up.Conclusions :a multimodal imaging evaluation is mandatory in order to better evaluate the patient with dome-shaped macula and its complications and to choose the best treatment in each case. To date, there is no validated therapy leading to DSM-related SRD resolution. Many different therapeutic approaches to SRD secondary to DSM have been attempted, with variable results.A combined treatment PDT and subthreshold 577 nm micropulse laser, with different therapeutic targets, has not been evaluated yet. In our experience, “combo therapy” can be considered an effective and safe therapy in the treatment of SRD secondary to DSM.

Obiettivo: valutare la variazione di spessore retinico maculare dopo trattamento combinato: fotodinamica (pdt) e laser giallo sotto soglia micropulsato nei pazienti con distacco sieroso del neuroepitelio (DNE) secondario a “dome shaped “refrattari a light fotodinamica(PDT), sicurezza ed efficacia di tali trattamenti. materiali e metodi: pazienti con diagnosi di DNE secondaria a dome shaped macula trattati presso la Clinica Oculistica di Ancona. Tutti i pazienti sono stati sottoposti a visita oculistica ,retinografia , autofluorescenza retinica,fluorangiografia (fag), esame al verde indocianina(icga),sd-oct,EDI-oct. 11 occhi miopi di 11 pazienti 8 di sesso femminile e 3 maschile con un’età media di 48 anni già sottoposti, almeno nei 3 mesi antecedenti, a light PDT e scarsamente responsivi a tale terapia sono stati oggetto di studio. Tutti i pazienti sono stati sottoposti a light PDT ICGA-guidata e dopo 2 settimane ad una seduta di laser giallo micropulsato sottosoglia 577. Risultati: alll’ultimo follow-up si mostravano uno spessore coroideale medio pari a 183.3μm (SD 75 .41μm) e uno spessore retinico foveale pari a 271.8μm (SD 64.19μm). Sono stati considerati responders i pazienti che mostravano una riduzione del DSNF > 30% rispetto al baseline. I responders al follow-up dei 6 mesi risultavano essere 5 occhi di 5 pazienti, con risoluzione del distacco sieroso in 2 occhi già rilevabile all’OCT eseguito alla visita di follow-up dei 3 mesi. Per quanto concerne l’acuità visiva in 6 occhi si è riscontrato un aumento di almeno 2 linee della BCVA, nessun peggioramento della BCVA né un aumento dello spessore retinico foveale è stato osservato Conclusioni:. Nel nostro studio abbiamo utilizzato la “combo therapy” ,PDT con effetto angio- occlusivo coroideale e laser giallo 577 micropulsato sottosoglia volto a stimolare l’attività di pompa dell’EPR i quali sembrano avere un effetto sinergico su due vie eziopatogenetiche alla base del distacco sieroso in dome shaped macula. Tale approccio si è rivelato sicuro nei pazienti presi in esame in quanto nessun paziente ha mostrato un peggioramento della BCVA né un aumento del DSNF né comparsa di neovascolarizzazione coroideale.

Terapia combinata nella gestione delle complicanze in dome-shaped macula: esperienza della clinica oculistica di Ancona / Pirani, Vittorio. - (2020 Mar 09).

Terapia combinata nella gestione delle complicanze in dome-shaped macula: esperienza della clinica oculistica di Ancona

PIRANI, VITTORIO
2020-03-09

Abstract

Purpose: the aim of the present study is to report on the results obtained in a pilot study with a combined treatment of half-fluence half-dose photodynamic therapy (PDT) and subthreshold 577 nm micropulse laser treatment (STLT) for SRD(sub retinal detachment) related to DSM(dome shaped macula) poorly responsive to previous LIGHT-PDT: Efficacy and Safety. Methods : 11 Patients (8 females and 3 males) referred to the Department of Ophthalmology of University Politecnica delle Marche with the diagnosis of symptomatic DSM were prospectively enrolled in the study. Inclusion criteria included the diagnosis of symptomatic DSM, associated with SRD; DSM was regarded as symptomatic whenever associated with visual acuity deterioration and distortion. DSM definition was based on the OCT identification of an inward bulge inside the chorioretinal posterior concavity of the macular area, according to Gaucher’s description. Patients who had undergone any previous treatment in the last 3 months or were affected by any other ocular disease were excluded from the study.Each patient underwent a complete ophthalmologic examination, including best-corrected visual acuity(BCVA) on standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts, blue-light fundus autofluorescence, fluorescein angiography ( FA), indocyanine green angiography (ICGA), OCT and OCT Angiography (OCTA). The patients were regularly scheduled. Each patient was first treated with half-fluence half-dose photodynamic therapy; after two weeks subthreshold 577 nm micropulse laser treatment was performed. Results :Overall, 11 eyes of 11 patients were included in the study. Subfoveal choroidal thickness was 183μm(SD 75.41μm ) and mean Central foveal thickness was 271.8μm (SD 64.19μm) to the last follow-up.Half-fluence half-dose photodynamic therapy and subthreshold micropulse laser treatment were uneventfully performed in all the cases, and were addressed to the ICGA- detected hyperfluorescent area. Serous retinal detachment diminished in all cases, and 5 eyes registered complete resolution at the end of the 6 month follow-up. No case showed enlargement of atrophic alterations, as assessed on blue-light fundus autofluorescence, or development of choroidal neovascularization at the end of the follow-up.Conclusions :a multimodal imaging evaluation is mandatory in order to better evaluate the patient with dome-shaped macula and its complications and to choose the best treatment in each case. To date, there is no validated therapy leading to DSM-related SRD resolution. Many different therapeutic approaches to SRD secondary to DSM have been attempted, with variable results.A combined treatment PDT and subthreshold 577 nm micropulse laser, with different therapeutic targets, has not been evaluated yet. In our experience, “combo therapy” can be considered an effective and safe therapy in the treatment of SRD secondary to DSM.
9-mar-2020
Obiettivo: valutare la variazione di spessore retinico maculare dopo trattamento combinato: fotodinamica (pdt) e laser giallo sotto soglia micropulsato nei pazienti con distacco sieroso del neuroepitelio (DNE) secondario a “dome shaped “refrattari a light fotodinamica(PDT), sicurezza ed efficacia di tali trattamenti. materiali e metodi: pazienti con diagnosi di DNE secondaria a dome shaped macula trattati presso la Clinica Oculistica di Ancona. Tutti i pazienti sono stati sottoposti a visita oculistica ,retinografia , autofluorescenza retinica,fluorangiografia (fag), esame al verde indocianina(icga),sd-oct,EDI-oct. 11 occhi miopi di 11 pazienti 8 di sesso femminile e 3 maschile con un’età media di 48 anni già sottoposti, almeno nei 3 mesi antecedenti, a light PDT e scarsamente responsivi a tale terapia sono stati oggetto di studio. Tutti i pazienti sono stati sottoposti a light PDT ICGA-guidata e dopo 2 settimane ad una seduta di laser giallo micropulsato sottosoglia 577. Risultati: alll’ultimo follow-up si mostravano uno spessore coroideale medio pari a 183.3μm (SD 75 .41μm) e uno spessore retinico foveale pari a 271.8μm (SD 64.19μm). Sono stati considerati responders i pazienti che mostravano una riduzione del DSNF > 30% rispetto al baseline. I responders al follow-up dei 6 mesi risultavano essere 5 occhi di 5 pazienti, con risoluzione del distacco sieroso in 2 occhi già rilevabile all’OCT eseguito alla visita di follow-up dei 3 mesi. Per quanto concerne l’acuità visiva in 6 occhi si è riscontrato un aumento di almeno 2 linee della BCVA, nessun peggioramento della BCVA né un aumento dello spessore retinico foveale è stato osservato Conclusioni:. Nel nostro studio abbiamo utilizzato la “combo therapy” ,PDT con effetto angio- occlusivo coroideale e laser giallo 577 micropulsato sottosoglia volto a stimolare l’attività di pompa dell’EPR i quali sembrano avere un effetto sinergico su due vie eziopatogenetiche alla base del distacco sieroso in dome shaped macula. Tale approccio si è rivelato sicuro nei pazienti presi in esame in quanto nessun paziente ha mostrato un peggioramento della BCVA né un aumento del DSNF né comparsa di neovascolarizzazione coroideale.
Dome shaped macula; photodynamic treatment; micropulsed laser under the threshold
dome shaped macula; trattamento fotodinamico; laser micropulsato sottosoglia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11566/273673
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