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array:24 [ "pii" => "S2173579420300505" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.01.014" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1632" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:248-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S036566912030040X" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.01.013" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1632" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:248-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Diagnóstico mediante imagen multimodal en síndrome paquicoroideo peripapilar: a propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "248" "paginaFinal" => "253" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnosis by multimodal imaging in peripapillary pachychoroid syndrome: A case report" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2830 "Ancho" => 2500 "Tamanyo" => 842574 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evolución de la OCT de AO. A y B. Exploración inicial, se observan drusas subretinianas y líquido intra y subretiniano asociado a DEP. Se inicia tratamiento con bevacizumab intravítreo en AO. C. Mejoría de la exudación en OD tras empleo de aflibercept en <span class="elsevierStyleItalic">treat and extend.</span> D. Empeoramiento de la exudación de OI a pesar de tratamiento con bevacizumab y aflibercept en <span class="elsevierStyleItalic">treat and extend</span>, se decide dejar de tratar. E. Empeoramiento de la exudación, con desprendimiento neurosensorial subfoveal a pesar del tratamiento. F. Mácula de OI mantiene gran desestructuración. G. OCT-EDI de OD tras 3 años de seguimiento, muestra aumento del líquido a nivel del haz papilomacular. En esa misma área de observan vasos dilatados a nivel coroideo (asteriscos). H. OCT-EDI de OI tras 3 años de seguimiento, gran desestructuración macular con líquido intra y subretiniano. Coroides con vasos dilatados (asteriscos) a nivel macular y del haz papilomacular.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Alonso-Martín, B. de-Lucas-Viejo, M. Gimeno-Carrero, M. Ferro-Osuna, J. Sambricio" "autores" => array:5 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Alonso-Martín" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "de-Lucas-Viejo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gimeno-Carrero" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Ferro-Osuna" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Sambricio" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579420300505" "doi" => "10.1016/j.oftale.2020.01.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420300505?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566912030040X?idApp=UINPBA00004N" "url" => "/03656691/0000009500000005/v2_202108170631/S036566912030040X/v2_202108170631/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579420300426" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.01.012" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1628" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:254-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Neuro-ophthalmological manifestations as complication of an infection with <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> and subsequent development of disseminated acute encephalitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "254" "paginaFinal" => "258" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manifestaciones neuroftalmológicas como complicación de una infección por <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> y desarrollo posterior de una encefalitis aguda diseminada" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1162 "Ancho" => 1740 "Tamanyo" => 201798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Supplementary tests of patient 1 (CPG) (A) angio-MRI images without alterations. (B) MRI with gadolinium of cervical spinal column without alterations. (C) axial MRI image in FLAIR sequence with gadolinium showing hyperintense lesions in the capsulo-thalamic region suggesting demyelinizing disease. (D) MRI taken 6 months after the first, showing absence of lesions. (E) Humphrey 24-2 campimetry within normal ranges in both eyes (minimum paracentral defect in LE).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Molero-Senosiain, B. Domingo-Gordo, C. Fernández Cabrera, E. Hernández-García, R. Gómez de Liaño" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Molero-Senosiain" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Domingo-Gordo" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Fernández Cabrera" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Hernández-García" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Gómez de Liaño" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120300368" "doi" => "10.1016/j.oftal.2020.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120300368?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420300426?idApp=UINPBA00004N" "url" => "/21735794/0000009500000005/v1_202005120955/S2173579420300426/v1_202005120955/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357942030044X" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.12.009" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "1638" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:244-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Vitreous amyloidosis as primary manifestation of disease: Case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "247" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Amiloidosis vítrea como manifestación primaria de enfermedad: reporte de caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 730 "Ancho" => 905 "Tamanyo" => 79665 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Postoperative right eye fundus photography. No evidence of opacity relapse.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. García Franco, A. Arias Gómez, M. García Roa, P. Ramírez Neria, S. Corredor Casas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García Franco" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Arias Gómez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "García Roa" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Ramírez Neria" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Corredor Casas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120300460" "doi" => "10.1016/j.oftal.2019.12.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120300460?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942030044X?idApp=UINPBA00004N" "url" => "/21735794/0000009500000005/v1_202005120955/S217357942030044X/v1_202005120955/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Diagnosis by multimodal imaging in peripapillary pachychoroid syndrome: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "248" "paginaFinal" => "253" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "B. Alonso-Martín, B. de-Lucas-Viejo, M. Gimeno-Carrero, M. Ferro-Osuna, J. Sambricio" "autores" => array:5 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Alonso-Martín" "email" => array:1 [ 0 => "Beatriz_alonso@live.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "de-Lucas-Viejo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gimeno-Carrero" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Ferro-Osuna" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Sambricio" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico mediante imagen multimodal en síndrome paquicoroideo peripapilar: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 527 "Ancho" => 1501 "Tamanyo" => 139666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) RE OCT-EDI, showing choroidal thickness measurements at the subfoveal level, at 1500 and 3000<span class="elsevierStyleHsp" style=""></span>μm from the fovea in nasal and temporal, respectively. (B) LE OCT-EDI showing choroidal thickness measurements at the subfoveal level and at 1500<span class="elsevierStyleHsp" style=""></span>μm of the fovea in nasal and temporal.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A disorder which is within the group of pachychoroid diseases, known as peripapillary pachychoroid syndrome (PPS)<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> has been recently described. Said group includes chronic serous central chorioretinopathy, polypoidal choroidal vasculopathy, choroidal focal cup and pachychoroid pigment epitheliopathy.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> The main impairment caused by said group is at the level of the choroids, that exhibit increased choroidal thickness at the expense of Haller's layer, the thickening of which involves thinning of the choriocapillary layer. In addition, said diseases exhibit hyperpermeability of choroidal vessels.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The increased choroidal thickness in PPS is particularly located at the peripapillary level, exhibiting intra-or subretinal fluid that arises from the temporal margin of the papilla and advanced is toward the macula, associating pigment epithelium detachments (PED).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A case with bilateral expression and its response to several treatments is described below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case</span><p id="par0020" class="elsevierStylePara elsevierViewall">Male, 73, with diminished visual acuity (VA) in the left eye (LE) with one year evolution. Relevant history includes diabetes mellitus tipo 2.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first examination was carried out in 2016, with VA of 0.7 in the right eye (RE) and 0.1 in the LE. Posterior pole and intraocular pressure of both eyes (BE) were normal. Eye fundus evidenced exudates at the posterior pole.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Optical coherence tomography (OCT) of both eyes (BE) identified subretinal drusen and intra-and sub-intraretinal fluid associated to PED (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). Considering that the case involved age-related macular degeneration, no additional supplementary tests were made.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The protocol at the authors’ center comprises only basic OCT in patients with age-related macular degeneration. Management of these patients involves intravitreal injections with charging dose (3 injections at 4-week intervals), followed by the <span class="elsevierStyleItalic">treat and extend</span> regime. A regime switch was considered when the patient failed to respond after 5 consecutive injections at 4-week intervals, starting with a charging dose of the new drug. If the patient exhibits VA<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.1 without improvement after the drug switch, the option of suspending treatment is taken into account.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Initially, intravitreous bevacizumab was prescribed in BE. The LE did not show improvements after 5 injections, and therefore the drug was switched to aflibercept. The patient maintained significant macular destructuring and finger counting VA after 5 injections. Accordingly, treatment was suspended (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D and F).</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the other hand, the RE did not improve either after 5 bevacizumab injections, thereby switching to aflibercept, extending the treatment interval up to a maximum of 8 weeks (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). After 5 injections without significant changes, an additional switch to ranibizumab was made. At present, the patient is being administered ranibizumab every 4 weeks due to non-resolution of intraretinal fluid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). Overall, the patient received 5 injections of bevacizumab, 15 of aflibercept and 7 of ranibizumab.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The macular edema exhibited fluctuating changes despite the injections, with improvements and worsenings regardless of the intravitreal medication. VA ranged between 0.5 and 0.7 in relation to the presence of subfoveal fluid as shown in OCT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, <span class="elsevierStyleSmallCaps">C</span> and E).</p><p id="par0060" class="elsevierStylePara elsevierViewall">In 2018, an article by Phasukkijwatana et al. described PPS and the management thereof by some authors with topical dorzolamide and oral acetazolamide.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It was decided to try these drugs in combined therapy with intravitreal medication without obtaining significant changes in the retinal edema.</p><p id="par0065" class="elsevierStylePara elsevierViewall">After the description of the syndrome, the differential diagnostic was considered for this patient and supplementary tests were performed, comprising OCT-<span class="elsevierStyleItalic">enhanced depth imaging</span> (OCT-EDI) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>G and H) which showed compatibility with choroidal disorder, emphasizing diffuse choroidal thickening notably in the nasal macular area and the peripapillary area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). The peripapillary area showed choriocapillary layer thinning, probably due to the compression exerted by underlying dilated choroidal vessels. Said vessels were more marked under the nasal macular.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Fluorescein angiography discarded a clear neovascular membrane. The RE showed stable peripapillary dotted hyperfluorescence in all times, associating patched hyperfluorescence in late times in the areas with PED (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The LE exhibited peripapillary dotted hyperfluorescence together with hypoperfusion areas. The posterior pole showed a hyperfluorescence area in late times due to the permeability of an underlying PED (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Autofluorescence showed hypoautofluorescent peripapillary atrophy together with dotted autofluorescence in the temporal edge of the optic nerve, adjacent to a hyperautofluorescent patch of the papillomacular bundle (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C). Said patch was located in the area with peripapillary subretinal fluid in OCT (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>D).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Fluorescein angiography with indocyanine green (FAIG) showed patched choroidal hyperpermeability in the posterior pole of the RE that increased in late times (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>E–G). The LE showed highly marked hypoperfusion in the peripapillary region due to deep choroidal ischemia at that level, being even more marked in late times (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>H–J).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">PPS is characterized by increased choroidal thickness (particularly in the peripapillary region) and intra- or subretinal fluid arising from the temporal margin of the papilla, and could associate other pachychoroidal disease characteristics such as PED.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Other findings included short axial length (AL), good VA, choroidal folds and papillary edema without neurological alteration.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The present case did not exhibit choroidal folds and AL was normal (RE 23.61<span class="elsevierStyleHsp" style=""></span>mm and LE 23.51<span class="elsevierStyleHsp" style=""></span>mm). In the RE, VA was good although the LE exhibited poor VA. This could be explained by the fact that the RE showed a typical image of the syndrome, whereas the LE seemed to be at a much more advanced stage. This is of significant interest because such highly aggressive forms of the disease have not been previously described.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Choroidal thickness was measured with OCT-EDI, identified increased thickness at the subfoveal level (RE 382<span class="elsevierStyleHsp" style=""></span>μm and LE 487<span class="elsevierStyleHsp" style=""></span>μm) and increased nasal choroids compared to the temporal choroids. In the RE the nasal thickness was 413<span class="elsevierStyleHsp" style=""></span>μm while the temporal was 282<span class="elsevierStyleHsp" style=""></span>μm (proportion 1.5); in the LE, nasal thickness was 358<span class="elsevierStyleHsp" style=""></span>μm and temporal was 253<span class="elsevierStyleHsp" style=""></span>μm (proportion 1.4) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). It has been demonstrated that patients with other pachychoroidal diseases such as central serous chorioretinopathy could exhibit an inverse proportion, i.e., diffusely thickened choroids, with the thickest point being subfoveal, followed by the temporal choroids.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Choroidal thickness increases have been associated to the peripapillary retinal pigment epithelium (RPE) dotting in autofluorescence, together with intraretinal cysts and PED in OCT. OCT-EDI showed thickened choroidal vessels in the same region. This description matches the description of PPS by Phasukkijwatana et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">On the other hand, the present case could be similar to the “uveal effusion isolated as the posterior level” syndromes that include thickened posterior choroids with macular serous detachment, cystic macular edema at the nasal level, choroidal folds and short AL without associating peripheral retinochoroidal detachment.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> This diagnostic was discarded because the patient did not exhibit choroidal folds and AL was normal. In addition, OCT-EDI showed dilated choroidal vessels in Haller's layer and hyperpermeability in FAIG late times. These findings are in contrast with diffuse granular hyperfluorescence in early FAIG times, described in uveal effusion syndromes.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In pachychoroidal diseases such as pachychoroidal pigment epitheliopathy it has been described that, if choroidal hyperpermeability is observed in FAIG, RPE alterations will be located in the same region.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> FAIG and OCT of the present patient showed similar findings, with RPE alterations and hyper permeability in the posterior pole (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>D–<span class="elsevierStyleSmallCaps">I</span>).</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is worthy of note that, even though the present patient exhibited thickened peripapillary pachychoroidal area, the more the disease progresses more ischemia will be found in the adjacent choroids, said ischemia being highly remarkable in FAIG of the LE.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The reason for the peripapillary thickening of the choroids is not clear. It has been proposed that intraretinal edema could originate in RPE atrophy areas associated to peripapillary choroidal congestion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> It could also be due to defects in the <span class="elsevierStyleItalic">lamina</span><span class="elsevierStyleItalic">cribrosa</span>.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In what concerns the course of the disease, the RE showed improvement or worsening regardless of the treatment, matching the course described in patients with PPS.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> However, the LE macula showed from the beginning a remarkable destructuring. In addition, these patients usually preserve a relatively good VA (0.6–0.7). This was verified in the RE but not in the LE, which maintained finger counting VA. This adds interest to the case because of asymmetrical evolution in BE, with the LE showing a clinic course that did not match descriptions by other authors.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">PPS must be differentiated from other pachychoroidal syndromes. It is characterized by increased choroidal thickness nasally to the macula, PED and sub- and intraretinal edema extending from the papillary margin. It associates patched RPE atrophy and typically shows hyperpermeability and peripapillary ischemia in FAIG.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Asymptomatic pachychoroidal syndromes can be observed and followed up without treatment. However, it would be necessary to treat cases with diminished VA that associate neovascularization with anti-VEGF or photodynamic therapy.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Scientific evidence to establish optimal management of cases exhibiting diminished VA without associated neovascularization is not sufficient. Additional studies are necessary to determine the origin of PPS and an accordingly adequate treatment of the disease.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1335176" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1229801" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1335175" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1229802" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-09" "fechaAceptado" => "2020-01-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1229801" "palabras" => array:6 [ 0 => "Pachychoroid syndrome" 1 => "Peripapillary" 2 => "Choroidal vessels" 3 => "Central serous chorioretinopathy" 4 => "Polypoidal" 5 => "Choroidal thickness" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1229802" "palabras" => array:6 [ 0 => "Síndrome paquicoroideo" 1 => "Peripapilar" 2 => "Vasos coroideos" 3 => "Coriorretinopatía central serosa" 4 => "Polipoidea" 5 => "Grosor coroideo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The case is reported of a 73-year-old male presenting with the recently described peripapillary pachychoroid syndrome. This syndrome is included in the pachychoroid diseases, which is a relatively new condition characterized by increased choroidal thickness with attenuation of the choriocapillary layer located above dilated choroidal vessels. It is associated with progressive malfunction of the retinal pigment epithelium and neovascularisation. The case is presented with a multimodal image, in which some tests show signs not previously described. In addition, a description is presented of the asymmetric outcome of both eyes after multiple treatments, since the left eye has a very severe affectation, and is refractory to the treatment.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se presenta el caso de un varón de 73 años con el recientemente descrito síndrome paquicoroideo peripapilar. Este síndrome se incluye dentro de las enfermedades paquicoroideas, que constituyen una entidad relativamente novedosa caracterizada por un aumento del grosor coroideo con atenuación de la capa coriocapilar situada por encima de vasos coroideos dilatados. Asocia mal funcionamiento progresivo del epitelio pigmentario retiniano junto con neovascularización. Se presenta el caso con imagen multimodal, en la que algunas pruebas muestran signos no descritos previamente. Además, se describe la evolución asimétrica de ambos ojos tras múltiples tratamientos, ya que el ojo izquierdo presenta una afectación muy severa y refractaria al tratamiento.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alonso-Martín B, de-Lucas-Viejo B, Gimeno-Carrero M, Ferro-Osuna M, Sambricio J. Diagnóstico mediante imagen multimodal en síndrome paquicoroideo peripapilar: a propósito de un caso. Arch Soc Esp Oftalmol. 2020;95:248–253.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1698 "Ancho" => 1501 "Tamanyo" => 433004 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">OCT showing evolution of BE. (A and B) Baseline examination, showing subretinal drusen and intra- and subretinal fluid associated to PED. Treatment is established with intravitreous bevacizumab in BE. (C) Exudation improvement in RE after utilizing aflibercept in <span class="elsevierStyleItalic">treat and extend.</span> (D) Worsening of LE exudation despite treatment with bevacizumab and aflibercept in <span class="elsevierStyleItalic">treat and extend</span>, it was decided to suspend treatment. (E) Worsening of exudation, with subfoveal neurosensory detachment despite treatment. (F) Significant destructuring of macular LE. (G) RE OCT-EDI after 3 years follow-up, showing increased fluid at the level of the papillomacular bundle. The same area shows dilated vessels at the choroidal level (asterisks). (H) LE OCT-EDI after 3 years follow-up, showing significant macular destructuring with intra-and subretinal fluid. Choroids with dilated vessels (asterisks) at the level of the macula and the papillomacular bundle.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 527 "Ancho" => 1501 "Tamanyo" => 139666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) RE OCT-EDI, showing choroidal thickness measurements at the subfoveal level, at 1500 and 3000<span class="elsevierStyleHsp" style=""></span>μm from the fovea in nasal and temporal, respectively. (B) LE OCT-EDI showing choroidal thickness measurements at the subfoveal level and at 1500<span class="elsevierStyleHsp" style=""></span>μm of the fovea in nasal and temporal.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2517 "Ancho" => 1301 "Tamanyo" => 472783 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Supplementary tests after 3 years follow-up. (A and B) Retinal fluorescein angiography of BE with dotted presence of contrast, more marked in the peripapillary area. (C) Autofluorescence shows hypo-autofluorescent peripapillary atrophy together with dotted autofluorescence in the temporal edge of the optic nerve and hyperautofluorescent patches in the papillomacular bundle. (D) Correspondence of autofluorescence with OCT. (E) Early phase of fluorescein angiography with indocyanine green (FAIG) of RE. (F and G) Middle and late phases of RE FAIG, evidencing choroidal hyperpermeability. (H–J) LE FAIG, showing marked hypoperfusion in the peripapillary area due to deep choroidal ischemia at that level, even more remarkable in late times. (K and L) Latest ocular fundus retinographies of BE, with LE showing macular pigment alteration.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripapillary pachychoroid syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Phasukkijwatana" 1 => "K.B. Freund" 2 => "R. Dolz-Marco" 3 => "M. Al-Sheikh" 4 => "P.A. Keane" 5 => "C.A. 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