Abstract

P 268

PDT and intravitreal bevacizumab injections for the treatment of CNV secondary to PIC

Carolin Perz, Matthias Maier, Nikolaus Feucht, Ines Lanzl, Chris P. Lohmann
Augenklinik, Klinikum rechts der Isar, Technische Universität München, München

Objective
Punctate inner choroidopathy (PIC) is an inflammatory disorder of the choroid that occurs predominantly in young myopic women during the 2nd to 4th decade of life. In 25-69%, choroidal neovascularisation (CNV) may be found and lead to loss of visual acuity (VA).
Various therapeutic strategies have been reported in small case series studies including immunosuppressive therapy, laser photocoagulation, photodynamic therapy (PDT) and intravitreal injections of triamcinolone or bevacizumab.
In addition, the present case report aims to describe the therapeutic effect of PDT in combination with intravitreal bevacizumab injections in the treatment of CNV arising from PIC.
Methods
A 28-year-old female patient with bilateral myopia presented with scotomas, metamorphopsia and blurred vision in her right eye. Best corrected VA was 0.4 (OD) and 1.0 (OS). Ophthalmoscopy showed multiple creamy yellow spots scattered in the macular region of the right eye, the left eye was unremarkable. There were no anterior chamber or vitreous cells. In fluorescein angiography (FA), the right eye showed classic juxtafoveolar subretinal CNV secondary to PIC. An infectious etiology and immunological diseases were ruled out.
The patient was fully informed about treatment options and after obtaining informed consent she received PDT of her right eye followed by 3 intravitreal injections of bevacizumab in intervals of 4 weeks.
Results
At 4 weeks after the last injection, VA had improved from 0.4 to 0.9, after 4 months to 1.0. The metamorphopsias had resolved. FA showed a reduction in the size of the CNV, no signs of remaining exudation. Optical coherence tomography (OCT) revealed subretinal RPE disturbances but no fluid.
6 months later the patient presented with new visual loss of the right eye and best corrected VA of 0.8 decreasing on follow-up visits. FA showed new lesions with leakage suspecting CNV. The indication for a further PDT followed by 3 intravitreal injections of bevacizumab was made. With treatment 14 months after first presentation VA of the right eye could be stabilized at 0.8.
Conclusions
The clinical observations suggest that treatment of classic CNV with PDT and intravitreal injections of bevacizumab may lead to an improvement of VA in patients with PIC. It therefore might be a considerable treatment option. It is to be noted, however, that neovascular lesions may reoccur and repeated treatment may be requested to achieve a stable situation.

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