Dados do Trabalho

Título

Peripheral exudative hemorrhagic chorioretinopathy managed with cryotherapy and intravitreal aflibercept

Objetivo

The purpose of this report is to describe a case of PEHCR, its clinical features and the good response to combined treatment of cryotherapy and intravitreal aflibercept.

Relato do caso

A 83 year-old female was referred to our clinic for evaluation of the retinal periphery. She had a history of arterial hypertension and type 2 diabetes and had been submitted to cataract surgery 2 years earlier. Her main complaint was worsening of central visual acuity for the past 5 years. Her best-corrected visual acuity (BCVA) was 20/80 in the right eye and 20/60 in the left eye. She was pseudophakic and her intraocular pressure was 10 mmHg in both eyes. Ophthalmoscopy revealed geographic atrophy in the posterior pole and an exudative lesion in the temporal periphery of both eyes. Fluorescein angiography showed hyperfluorescence due to a window defect in the perifoveal region and a late and irregular hyperfluorescence (leakage) in the temporal periphery of both eyes. Ultrasonography (US) showed a discrete and irregular retinochoroidal thickening in the temporal sector of both eyes. The lesion dimensions were 7.5 x 5.1 x 1.6 mm (vertical x horizontal x height) in the right eye. The diagnosis of PEHCR was made and we decided just to observe this patient due to the lack of macular involvement. She came back 3 months later, complaining of worsening of visual acuity in the right eye. Her BCVA was count fingers in the right eye and remained 20/60 in the left eye. US showed a retinal detachment and increasing of lesion dimensions in the right eye: 11,4 x 9,7 x 1,6 mm(vertical x horizontal x height).Spectral domain OCT [SD-OCT; Spectralis OCTTM (Heidelberg Engineering, Heidelberg, Germany)] showed sub-retinal fluid reaching the macula in the right eye. Treatment options and their potential benefits and complications were discussed with the patient. She was then treatedwithcryotherapy followed by three monthly intravitreal injections of aflibercept. She presented an excellent functional and anatomical result. SD-OCT showed complete resolution of the subretinal fluid and BCVA returned to 20/80 in the right eye one month after the third intravitreal injection. No new active exudative lesion was observed in the following three months.

Discussão

PEHCR is a rare exudative disease of the peripheral retina that may be accompanied by AMD-related findings such as geographic atrophy. A good response to combined treatment with cryotherapy and aflibercept might be expected.