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Federico Zicarelli, Chiara Preziosa, Giovanni Staurenghi, Marco Pellegrini; ACTIVE TREATMENT VERSUS OBSERVATION IN PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY: A MULTIMODAL IMAGING STUDY.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1905.
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© ARVO (1962-2015); The Authors (2016-present)
To compare active treatment versus observation of Peripheral Exudative Hemorrhagic Chorioretinopathy (PEHCR) using wide field imaging with focus on the role of wide-field OCT in the follow up.
Retrospective case series of 22 eyes from 17 patients diagnosed with PEHCR from 2009 to 2018 and followed at Luigi Sacco Hospital, University of Milan, Italy. Each patient underwent a multimodal imaging examination including wide field fundus photographs (Optos California Ultrawide-field), near-infrared reflectance (NIR), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT) using the HRA + OCT Spectralis platform (Heidelberg Engineering). B-scan ultrasound was used in selected cases. Patients were classified according to the prognosis based on the macular involvement, and the type of treatment (observation vs intravitreal injection of anti-VEGF vs photodynamic therapy (PDT).
Mean age was 80 (range 69-92) and BCVA was 0.47 at baseline and 0.5 at the last follow up. On the basis of the wide field imaging, pigment epithelial detachments (PED) were present in 18 eyes (81%), and were hyporeflective in 14 eyes (63%), hyperreflective in 6 eyes (27%), and mixed in 10 eyes (45%). Sub-retinal fluid was present in 17 eyes (77%) and subretinal blood in 17 eyes (77%). According to ICGA, polipoidal dilations were detected in 14 eyes (64%) and diffuse neovascular network in 6 eyes (27%). According to OCT scans 19 eyes had a favorable prognosis at the last visit (86%), while 3 eyes had an unfavorable prognosis (14%). The 19 eyes with good prognosis have been divided into: the no treatment group that included 9 eyes (47%), and the active treatment group with 10 eyes (53%). The active treatment consisted in intravitreal anti-VEGF treatment (IVT) for 3 eyes, photodynamic therapy (PDT) for 1 eye, and both IVT and PDT for 6 eyes. Of the 3 eyes with unfavorable prognosis, 2 eyes underwent observation, and 1 eye with IVT. No statistical difference between groups has been obtained (exact Fisher test).
Our study showed that PEHCR usually yield a favorable visual prognosis beside the management choice, with active treatment warranted in macular threatening lesions. Wide field NIR and the OCT proved to be good tools to monitor the disease activity.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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