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      Progressive Massive Choroidal Neovascularization, an Aggressive Phenotype: Case Report

      case-report

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          Abstract

          We report 2 cases of an aggressive choroidal neovascularization phenotype. A 77-year-old hypertensive woman, with a 4-year history of visual loss in her left eye, due to vitreous hemorrhage associated with a dome-shaped mass lesion underwent pars plana vitrectomy. An extensive subretinal hemorrhage was found, associated with extensive subretinal fibrosis, which was treated with endophotocoagulation and intravitreal injection of anti-VEGF. Best-corrected visual acuity after surgery was light perception. A 74-year-old woman with a 4-year history of treatment for choroidal neovascularization in both eyes presented with an extensive subretinal hemorrhage associated with exudation in the temporal peripheral retina. Lesions became larger despite monthly intravitreal anti-VEGF injections (14 injections) and verteporfin photodynamic therapy in both eyes. Throughout the years, the choroidal neovascular lesion continued to enlarge until it developed a severe vitreous hemorrhage. The patient rejected treatment and ended up with no light perception at the end of the follow-up (8 years). A rare severe choroidal neovascularization phenotype is presented here and would be considered to be at the aggressive extreme of the spectrum of a neovascular age-related macular degeneration or polypoidal choroidal vasculopathy that presents massive hemorrhage and exudation as much as in the posterior pole as in the peripheral retina.

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          Most cited references13

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          Incidence Rate of Massive Submacular Hemorrhage and its Risk Factors in Polypoidal Choroidal Vasculopathy

          To investigate the incidence rate of massive submacular hemorrhage (SMH) in patients with polypoidal choroidal vasculopathy (PCV) and analyze the associated risk factors.
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            Genetic associations in polypoidal choroidal vasculopathy: A systematic review and meta-analysis

            Purpose To investigate the genetic associations of polypoidal choroidal vasculopathy (PCV), the genetic difference between PCV and age-related macular degeneration (AMD), and the genotype-phenotype correlation of PCV. Methods A systematic review and meta-analysis were performed. Published articles about genetic associations of PCV identified from a literature search were reviewed. The following data from individual studies were extracted and analyzed: 1) comparison of genetic polymorphisms between PCV and controls; 2) comparison of genetic polymorphisms between PCV and AMD; and 3) comparison of phenotypes between different genotype groups. Results A total of 33 articles fulfilled the inclusion criteria. With meta-analyses, variants in four genes were found to be significantly associated with PCV: LOC387715 rs10490924 (n=9, allelic odds ratio [OR]=2.27, p<0.00001), HTRA1 rs11200638 (n=4, OR=2.72, p<0.00001), CFH rs1061170 (n=4, OR=1.72, p<0.00001), CFH rs800292 (n=5, OR=2.10, p<0.00001), and C2 rs547154 (n=3, OR=0.56, p=0.01). LOC387715 rs10490924 was the only variant showing a significant difference between PCV and wet AMD (n=5, OR=0.66, p<0.00001). The risk genotypes of rs10490924 were associated with larger lesion size, greater chance of vitreous hemorrhage, and worse therapeutic response in PCV. Conclusions LOC387715 rs10490924 was associated with PCV and its clinical manifestations, and showed a discrepant distribution between PCV and AMD. Variants in HTRA1, CFH, and C2 were also associated with PCV.
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              The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis

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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2022
                May - August 2022
                28 June 2022
                : 13
                : 2
                : 490-498
                Affiliations
                [_a] aRetina Department, Instituto de La Retina Del Bajío, INDEREB, Santiago de Querétaro, Mexico
                [_b] bRetina Department, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, Mexico
                [_c] cPosgraduate School, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
                [_d] dOcular Ultrasound Service, Clínica David, Unidad Oftalmológica, Morelia, Mexico
                [_e] eRetina Department, Clínica David, Unidad Oftalmológica, Morelia, Mexico
                [_f] fPostgraduate School, School of Medicine, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
                Author information
                https://orcid.org/0000-0003-1970-799X
                https://orcid.org/0000-0001-5125-1342
                https://orcid.org/0000-0001-5882-3462
                Article
                525269 PMC9294954 Case Rep Ophthalmol 2022;13:490–498
                10.1159/000525269
                PMC9294954
                35950030
                f48f3535-8451-4ec6-bbd7-e09dd3c7cd73
                © 2022 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                History
                : 18 January 2022
                : 18 May 2022
                Page count
                Figures: 3, Pages: 9
                Funding
                The author(s) received no financial support for the research, authorship, and/or publication of this article.
                Categories
                Case Report

                Vision sciences,Ophthalmology & Optometry,Pathology
                Choroidal neovascularization,Polypoidal choroidal vasculopathy,Age-related macular degeneration

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