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C.I. Frennesson, R. Larsson, P. Hultman, S.G. Nilsson; Drusen and Choroidal Neovascularization (CNV) in Patients with Dense Deposit Disease (Membrano-proliferative Glomerulonephritis Type II). Favourable Effect of Photodynamic Treatment (PDT) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1774.
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Purpose: The pathognomonic lesion in dense deposit disease (DDD), also referred to as membranoproliferative glomerulonephritis type II (MPGN II), is ultrastructurally very dense intramembranous deposits in the glomerular and tubular basement membranes and in Bowman’s capsule. Similar deposits have also been observed in the spleen and in Bruch’s membrane from DDD patients. The aim of the study was to identify biopsy-proven cases of DDD in our health care region, to study the presence of fundus changes in these patients, and the effect of PDT. Methods: Among more than 2300 biopsies performed on native kidneys in a population of 950.000 inhibitants over a 25-year period, we identified 3 adult patients with DDD. The three men were aged 40, 74 and 76, respectively. The duration of the disease varied from 2 to 18 years. The patients underwent a thorough ophthalmological examination, including visual acuity (ETDRS-chart), visual field, biomicroscopy of the posterior segment (dilated), fundus photo and fluorescein angiography. In one patient, ICG-angiography was also performed. Results: Visual acuity ranged from 20/200 to 20/20. Fundoscopi showed retinal pigment epithelium defects and drusen-like lesions, and fluorescein angiography (FA) revealed multiple, hyperfluorescent foci. In the youngest patient, with a duration of 18 years, visual acuity was severely reduced in one eye because of a CNV. Later he developed a classic CNV in the fellow eye and was treated with PDT (verteporfin). After 2 treatments, there was no leakage on FA. Visual acuity increased from 20/33 to 20/16. Near vision was 4 points. A limited paracentral scotoma decreased after treatment. Total follow-up is 6 months. Conclusions: DDD is a rare disease, also showing drusen-like deposits and in some cases CNV. In the latter form, PDT seems to be beneficial.
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