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Giacomo Abbruzzese, Alba Miele, Maria Carla Donati, Fabrizio Giansanti, Matteo Giuntoli, Ugo Menchini; Treatment Of Macular Serous Detachment In Tilted Disc Syndrome: Report Of Three Cases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5194.
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To describe functional and anatomic results obtained by treatment with photodynamic therapy (PDT) or intravitreal bevacizumab (Avastin, Roche) in macular serous retinal detachment associated with tilted disc syndrome.
Three eyes of three patient with symptomatic macular serous detachment associated with tilted disc syndrome (optic disc with an oblique axis, inferonasal crescent and inferior staphyloma) were treated. In all patients best corrected visual acuity (BCVA) was tested and fluorescein angiography (FA) and OCT were performed before and about 45 days after treatment. All patients underwent a complete ophthalmologic examination including OCT at least 6 months after treatment. The first patient was treated with one low fluence (300 mW/cm² for 83sec)PDT (6 months follow up). The second patient was treated with 3 intravitreal injections of bevacizumab 1.25 mg (33 months follow up) and to the third patient were delivered in 4 months two low fluence PDTs, and, after one year, 3 intravitreal injections of bevacizumab 1.25 mg (37 months follow up).
Before treatment all patients complained of visual loss and metamorphopsia. OCT showed in the macular area a focal neurosensory detachment with foveal involvement. FA showed in the macular area multiple focal areas of hyperfluorescence due to pigment epithelium atrophy and in the second and third patient also a hyperfluorescent pinpoint with minimal leakage. After treatment in all eyes symptoms didn’t change, BCVA remained stable and in OCT the foveal neuroretinal detachment was changeless. In FA no noticeable variation of the hyperfluorescence areas was appreciated. In the second patient the hyperfluorescent point remained unvaried, and the same occurred in the third patient after the first PDT, while after the second PDT a new leaking dot disappeared.
Macular serous retinal detachment has been first described in 1998 as an uncommon complication of tilted disc syndrome showing angiographic and optical coherence tomography features similar to a chronic central serous chorioretinopathy. In contrast to this pathology, in our patients treatment with PDT or intravitreal bevacizumab didn’t succeed, probably because of a different pathogenesis of macular serous detachment. Further investigations are needed to clarify the proper therapy of this disease.
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