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Alejandro Zermeno, Ricardo Moreno; Treatment of Relentless Placoid Choroidopathy with Intravenous Cyclophosphamide: A case series. Invest. Ophthalmol. Vis. Sci. 2018;59(9):424. doi: https://doi.org/.
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Relentless Placoid Choroiditis (RPC) is a very rare, recently described and usually bilateral indolent disease with prolonged and progressive clinical course, widespread lesions and unknown etiology. There’s no established treatment or guidelines for this pathology due to it’s rareness. The purpose of this study is to describe the results of a case series of three patients with RPC who were treated with an IV cyclophosphamide pulse.
Three patients evaluated in the Uveitis department of the Instituto de Oftalmología F.A.P. “Conde de Valenciana” with clinical diagnosis of RPC were included in this case series. All of them had blood tests to rule out other differential diagnosis.
First Case: Twenty-year-old female patient, complains of diminished visual acuity and photopsias in her left eye for one week.The best corrected visual acuity at the moment of the first consultation was 20/40 in her right eye and count fingers at one feet in the left. The eye fundus showed greyish subretinal plaques that involved the peripapillary and the macular areasAfter 4 cycles of intravenous cyclophosphamide BDVA improved to 20/25 and 20/50 respectively and remained like that after 6 months of follow-up with no relapses.Second Case: 15 years old male patient. He complained of blurred vision in the past 6 weeks, malaise, headache. BCVA 20/80 in both eyes. White placoide lesions were evident in the posterior pole of both eyes. The patient recieved 3 IV pulses of cyclophosphamide one month appart and came back two month later with a BCVA of 20/20 and 20/40.The third case is a 19 years old female that presented bilateral blurred vision for two months that became worse in the last three days. In the initial evaluation BCVA was 0.5 LogMAR in the right eye and 0.4 LogMAR in the left eye. The eye fundus showed abundant pigmented placoid lesions that involved the macular area and the vascular arcades. She recieved two intravenous dosis of cyclophosphamide, BCVA improved to 20/30 and 20/50 respectively with no cells or flare in any chamber in either eye, and no signs of relapse.
All 3 patients had an adecuate response to the cyclophosphamide treatment, no reactivation was seen in any patient.Intravenous cyclophosphamide could become a treatment option for patients with RPC.More studies are needed to create a more precise management guideline for this pathology.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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