Unfavorable effect of photodynamic therapy for late subretinal neovascularization with chorioretinal anastomoses associated with idiopathic multiple serous detachments of the retinal pigment epithelium.
OBJECTIVE
To describe a case of a 46-year-old woman with an asymptomatic history of unilateral multiple serous detachments of the retinal pigment epithelium (PED) in the right eye, treated with photodynamic therapy (PDT) with verteporfin for recent onset of subfoveal choroidal neovascularization (CNV) with chorioretinal anastomoses (CRA).


METHODS
Case report.


RESULTS
Fluorescein and indocyanine green (ICG) angiography, performed with a Heidelberg scanning laser ophthalmoscope (SLO), demonstrated a predominantly classic foveal choroidal neovascular membrane associated with a PED and 1 one retinal and 2 two venous chorioretinal anastomoses. The left fundus was normal. PDT therapy was performed according to standard techniques. Three PDT treatments were performed at an interval of 3 months. Three months after the second PDT, visual acuity dropped to 20/200, with an enlargement of the neovascular network. One month after the third treatment, visual acuity deteriorated further and the CRA appeared enlarged, associated with a dense fibrotic reaction in the centere of the lesion.


CONCLUSIONS
This clinical observation demonstrates that idiopathic serous detachments of the retinal pigment epithelium may represent predisposing changes to CNV development, and in the case CNV is associated with CRA, PDT may be unsuccessful.
Fossarello
M
M
Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari - Italy. mfossarello@libero.it
Peiretti
E
E
Zucca
I
I
Serra
A
A
D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008875:Middle Aged; D009887:Ophthalmoscopy; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D010857:Pigment Epithelium of Eye / Q000473:pathology; D011166:Porphyrins / Q000627:therapeutic use; D012163:Retinal Detachment / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012171:Retinal Vessels / Q000002:abnormalities*; D017211:Treatment Failure; D000077362:Verteporfin; D014792:Visual Acuity
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D007208:Indocyanine Green