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array:24 [ "pii" => "S2173579420301572" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.05.018" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1726" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:157-61" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669120301970" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.05.019" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1726" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:157-61" "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" => "Paquicoroidopatía peripapilar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "161" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Peripapillary pachychoroidopathy" ] ] "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" => 657 "Ancho" => 1674 "Tamanyo" => 94254 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Caso 1. OCT. Se observa en ambos ojos un aumento del grosor coroideo y paquivasos en región parapapilar junto a un DEP parapapilar en el OD y un DEP de menor tamaño en el haz papilomacular en OI. Destaca en ambos ojos un moteado en la retinografía en las regiones parapapilar y macular, y la hiperfluorescencia irregular en la AFG en dichas zonas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.L. Sánchez-Vicente, A.C. Martínez-Borrego, F.E. Molina-Socola, C. Franco-Ruedas, M.A. Espiñeira Periñán, F. López-Herrero" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.L." "apellidos" => "Sánchez-Vicente" ] 1 => array:2 [ "nombre" => "A.C." "apellidos" => "Martínez-Borrego" ] 2 => array:2 [ "nombre" => "F.E." "apellidos" => "Molina-Socola" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Franco-Ruedas" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Espiñeira Periñán" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "López-Herrero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579420301572" "doi" => "10.1016/j.oftale.2020.05.018" "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/S2173579420301572?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120301970?idApp=UINPBA00004N" "url" => "/03656691/0000009600000003/v1_202102280701/S0365669120301970/v1_202102280701/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579420301201" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.03.012" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1686" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:162-6" "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" => "Focal laser for idiopathic macular telangectasia type 1 refractory to ozurdex, ranibizumab and aflibercept" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "162" "paginaFinal" => "166" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Láser focal para telangectasia macular idiopática tipo 1 refractario a ozurdex, ranibizumab y aflibercept" ] ] "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" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1168 "Ancho" => 1740 "Tamanyo" => 324142 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) RE retinography showing capillary macroaneurysm in the temporal para fovea and thick lipid exudates in macular star pattern. Normal LE retinography. b) SD-OCT image showing CME as well as the capillary macroaneurysm (yellow arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H.E. Tapia Quijada, S. Gómez Perera, I. Rodríguez Talavera, C. Mantolan Sarmiento, P. Rocha Cabrera, M. Díaz de Aguilar Osona, M. Serrano García" "autores" => array:7 [ 0 => array:2 [ "nombre" => "H.E." "apellidos" => "Tapia Quijada" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Gómez Perera" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Rodríguez Talavera" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Mantolan Sarmiento" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Rocha Cabrera" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Díaz de Aguilar Osona" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Serrano García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120301416" "doi" => "10.1016/j.oftal.2020.03.022" "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/S0365669120301416?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301201?idApp=UINPBA00004N" "url" => "/21735794/0000009600000003/v1_202102280652/S2173579420301201/v1_202102280652/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579420301274" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.05.010" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1739" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:152-6" "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" => "Atypical toxoplasmic retinochoroiditis in patients with malignant hematological diseases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "152" "paginaFinal" => "156" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Retinocoroiditis toxoplásmica de presentación atípica en pacientes con enfermedades hematológicas malignas" ] ] "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" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1187 "Ancho" => 1505 "Tamanyo" => 155332 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right eye ultra-widefield (UWF) retinal imaging and Autofluorescence (AF) imaging. A shows two focus of active chorioretinitis, one extensive peripapilar inferior focus and other temporal superior focus. The AF in B presents hiperautofluorescence along the edge of the hipoautofluorescent lesions. After antibiotic treatment, both lesions appear more scared (C) and both of them reveal hipoautofluorescence, indicating inactivity (D). Figure corresponding to case 3.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.P. Figueroa-Vercellino, L. Miguel, A. Moll-Udina, C. Alba-Linero, V. Llorenç, A. Adán" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.P." "apellidos" => "Figueroa-Vercellino" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Miguel" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Moll-Udina" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Alba-Linero" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Llorenç" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Adán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120302100" "doi" => "10.1016/j.oftal.2020.05.032" "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/S0365669120302100?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301274?idApp=UINPBA00004N" "url" => "/21735794/0000009600000003/v1_202102280652/S2173579420301274/v1_202102280652/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Peripapillary pachychoroidopathy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "161" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.L. Sánchez-Vicente, A.C. Martínez-Borrego, F.E. Molina-Socola, C. Franco-Ruedas, M.A. Espiñeira Periñán, F. López-Herrero" "autores" => array:6 [ 0 => array:3 [ "nombre" => "J.L." "apellidos" => "Sánchez-Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "A.C." "apellidos" => "Martínez-Borrego" "email" => array:1 [ 0 => "anacmartinezborrego@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "F.E." "apellidos" => "Molina-Socola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Franco-Ruedas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M.A." "apellidos" => "Espiñeira Periñán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "F." "apellidos" => "López-Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Oftalmología, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paquicoroidopatía peripapilar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 447 "Ancho" => 1800 "Tamanyo" => 82435 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Case 4. A) OCT LE. Parapapillary SRF with choroidal thickening, pachyvessels and thinning of internal choroidal layers. B) OCT-A of LE, where no signs of neovascularization can be observed.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The peripapillary pachycoroid syndrome (PPS) has recently been described by Phasukkijwatana and Freund as a variant of the pachycoroid disease spectrum,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which refers to a group of diseases including pachychoroidal pigment epithelial disease (PPD),<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> central serous chorioretinopathy (CSC),<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> choroidal neovascularization (CNE),<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> choroidal polypropylene vasculopathy<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and choroidal focal excavation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The term pachychoroid (pachy [prefix]: thick) was proposed as a term indicating an abnormal and persistent increase in choroidal thickness.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the case of peripapillary pachychoroidopathy, the maximum choroidal thickness is in the vicinity of the optic nerve. These patients typically have intraretinal or subretinal fluid in the macular nasal area, with occasional optic nerve edema, often associated with other alterations of the pachychoroid, such as pachychoroid-associated epithelial disease, choroidal hyperpermeability, dilatation of Haller layer vessels (pachyivessels), retinal pigment epithelium detachment (RPD) and gravitational tracts, which are usually located in the peripapillary region.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic cases</span><p id="par0015" class="elsevierStylePara elsevierViewall">An 8-eye retrospective study of 5 patients between 47 and 65 years of age was conducted. The average follow-up time of the cases was 2 years and 11 months.<span class="elsevierStyleEnunciation" id="enun0005"><span class="elsevierStyleLabel">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">is a 64-year-old male with diabetes type 2, referred to our service for an ocular fundus (OF) study. Best corrected visual acuity (BCVA) was 0.1 in the right eye (RE) and 0.7 in the left eye (LE). Using high-penetration optical coherence tomography (OCT) (DRI OCT Triton plus, Topcon Medical Systems, Inc. Oakland, NJ 07436, USA), foveal atrophy with loss of thickness of the outer layers of the retina was observed in the RE and parapapillary PED in the LE, accompanied by dilation of Haller layer vessels and thinning of the choroidal inner layers at that level. The choroidal thickness measured in the papillomacular bundle of the LE was 392 µs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></p><p id="par0025" class="elsevierStylePara elsevierViewall">Fluorescein angiography (FAG) showed spotted peripapillary and macular level of the RPE in both eyes with irregular hyperfluorescence that increased throughout the test, but without late diffusion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Five months later, LE was complicated by a choroidal neovascular membrane, which was treated with 3 intravitreal injections of antiangiogenic (anti-VEGF) (aflibercept) with positive response. Two months after this treatment, a small serous detachment of the parapapillary neuroepithelium was observed in the RE, accompanied by vascular dilatation at Haller layer level, thinning of the Sattler layer and chorioid layer and no signs of neovascular activity in OCT and OCT angiography (OCT-A). The patient was treated with eplerenone 50 mg/day, remaining stable, with a BCVA of 0.2 in the RE and 0.5 in the LE.<span class="elsevierStyleEnunciation" id="enun0010"><span class="elsevierStyleLabel">Case 2</span><p id="par0035" class="elsevierStylePara elsevierViewall">is a 62-year-old female who presented with diminished visual acuity (BCVA 0.4) and metamorphoses in the RE with 3 months evolution. Examination of the RE revealed pigment dispersion in the macular area. OCT showed in the RE the presence of a NESD in the papillomacular bundle. The greatest choroidal thickness was located in the peripapillary region, being 431 µs at the midpoint of the NESD. We also observed pachyivessels in the Haller layer and thinning of the Sattler layer and the choriocapillary layer at that level (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></p><p id="par0040" class="elsevierStylePara elsevierViewall">In FAG, an irregular papillomacular bundle hyperfluorescence was observed in the RE, which became more evident in later times but without diffusion or signs of neovascular activity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><p id="par0045" class="elsevierStylePara elsevierViewall">One year and 10 months later, said patient presented a venous thrombosis of the lower temporal branch in the RE, which was treated with 3 intravitreal injections of anti-VEGF (ranibizumab), with good response. However, a year and 8 months later OCT showed a new PED in the RE. Treatment was then initiated with eplerenone 25 mg for one week and then 50 mg for 6 months, until complete resolution of the PED. BCVA of RE after such treatment was 0.3. The LE showed normal OF, OCT and FAG.<span class="elsevierStyleEnunciation" id="enun0015"><span class="elsevierStyleLabel">Case 3</span><p id="par0050" class="elsevierStylePara elsevierViewall">is a 56-year-old female diagnosed with retrobulbar optic neuritis of LE, referred for follow-up by our service. BCVA in RE was 0.6 and finger counting in LE. A small inferior parafoveal PED and the presence of juxtapapillary subretinal fluid (SRF) were observed in the RE OCT. In the LE the OCT showed a small juxtapapillary PED and another lower parafoveal PED. In both eyes it was associated with pachychoroids and dilatation of the vessels of the Haller layer in the peripapillary region and papillomacular bundle, while the Sattler layer and the choriocapillary layer were thinned. The choroidal thickness measured at the level of the papillomacular bundle was 411 µs at the RE and 409 µs at the LE (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the OF, a large macular area of atrophy and hypertrophy of RPE was observed in the RE, with FAG showing an irregular hyperfluorescence in papillomacular beam, with lower paramacular hypercapture point and in a lower temporal area. A focus of RPE hypertrophy was seen in the inferotemporal macular zone of the LE and more peripherally an area of atrophy and hypertrophy. FAG showed peripapillary spotted hyperfluorescence, papillomacular bundle and macular region (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment with eplerenone was established at 25 mg every 12 h. After one year, PED has decreased slightly in both eyes, although it persists. However, choroidal thickness remains unchanged. BCVA after treatment was 0.5 in the RE and hands movement in the LE.<span class="elsevierStyleEnunciation" id="enun0020"><span class="elsevierStyleLabel">Case 4</span><p id="par0065" class="elsevierStylePara elsevierViewall">is a 47-year-old female who underwent surgery for retinal detachment in RE. During follow-up, an upper nasal paramacular NESD and a temporary juxtapapillary SND associated with pachychoroids were observed in the LE through OCT. Choroidal thickness was 408 µs at the midpoint of the papillomacular bundle and was accompanied in the OCT by dilatation of the vessels of the Haller layer and decrease in the thickness of the Sattler and choriocapillary layers. OCT-A ruled out the existence of NMV (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). BCVA at that time was 0.8 in the LE. Treatment with eplerenone 25 mg/day was started for one week and maintained at 50 mg/day for one year. After treatment, a reduction in the RSL and a slight decrease in the size of the pachyvessels have been detected. The BCVA at the last check-up was 1 in LE.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></p><p id="par0070" class="elsevierStylePara elsevierViewall">Finally, case 5 is a 69-year-old man who underwent surgery for complicated LE cataract with posterior capsule rupture and dislocation of cortical remains into vitreous. An LE pars plana vitrectomy was performed to remove said cortical debris. During the follow-up, a PED with parapapillary SRF was found in both eyes, using OCT, accompanied by pachyvessels in Haller's layer and decreased thickness in the remaining choroidal layers (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). BCVA at that time was 0.9 in RE and 0.7 in LE. Parapapillary hyperfluorescence was observed in the FAG of RE, while LE papillary and parapapillary hyperfluorescence was irregular, without late diffusion. In this eye a post-surgical petaloid macular edema could also be seen in late times (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). At 2 months, LE macular edema was already resolved. Currently, 3 months after diagnosis, the patient remains stable and presents an BCVA of 1 in RE and 0.9 in LE.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">None of the above cases exhibited edema of the papilla or optic nerve fossa, or any other relevant ophthalmological anomaly or disease.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Advances in retinal imaging have provided new knowledge about a variety of chorioretinal disorders<span class="elsevierStyleSup">7</span>. Various imaging tests such as high-penetration OCT have enabled not only choroidal thickness measurement, but also observation of choroidal vessels morphology.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Similarly, studies performed with indocyanine green angiography have shown hyperpermeability of the choroidal vessels, in addition to an increase in their diameter.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">On the other hand, OCT-A allows high quality images of the choriocapillary and other choroidal vessels to be obtained in a non-invasive way, providing highly valuable information in the study of choroidal vascular alterations.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Said developments enabled the description of the pachycoroidal range of diseases, which includes PPS, recently described by Phasukkijwatana and Freund.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Pachychoroidopathy is a term that describes a phenotype characterized by a focal or diffuse increase in choroidal thickness, caused by a dilatation of the choroidal vessels in Haller's layer, accompanied by a thinning of the internal choroid (choriocapillary and Sattler's layer). Despite being a frequent finding, increased choroidal thickness is not in itself the most important criterion for diagnosis. The definition of pachychoroidopathy is given by the presence of characteristic morphological changes (pachyivessels, thinning of the Sattler and choriocapillary layer, choroidal hyperpermeability, etc.) which imply a structural and functional alteration of the choroid, and may lead to an ischemic environment that would stimulate the production of VEGF and subsequent neovascularization.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">PPS would be a form of pachychoroidopathy, in which the phenotype of the disease would be present in the vicinity of the optic disc rather than at the subfoveal level. Peripapillary choroidal congestion, secondary to the presence of pachyvessels and hyperpermeability, could lead to an increase in hydrostatic pressure below the RPE, resulting in RPE dysfunction and the appearance of fluid in the subretinal space.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been suggested that the presence of intraretinal fluid in the form of cysts would be due to the loss of barrier function of RPE and the external epirretinal membrane due to damage from choroidal congestion.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">With respect to eplerenone treatment, and due to the existence of publications showing possible efficacy in the use of mineralocorticoid antagonists in CSC, it was decided to use eplerenone in 4 of the patients, without obtaining significant improvements in choroidal thickness or visual acuity.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Asymptomatic patients can be followed by observation. Those who exhibit associated complications such as choroidal neovascularization or central macula involvement due to CSC can be administered the usual treatments, i.e., anti-VEGF or photodynamic therapy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion, some cases of peripapillary pachychoroidopathy are described as a new group of pachychoroid diseases, characterized by thickening of the choroid on the nasal side of the macula and around the optic disc with the presence of intra- and sub-retinal fluid in these areas, extending towards the optic disc. In a patient with suspected pachychoroidopathy, we should consider the specific study of the papillary area by means of high penetration OCT.</p><p id="par0125" class="elsevierStylePara elsevierViewall">It is important to know the characteristics of peripapillary pachychoroidopathy in order to distinguish it from other entities that might share similar manifestations such as inflammatory processes, neuro-ophthalmological diseases, vascular or tumor alterations.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1472806" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1341218" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1472807" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1341217" "titulo" => "Palabras claves" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic cases" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-18" "fechaAceptado" => "2020-05-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1341218" "palabras" => array:4 [ 0 => "Peripapillary pachychoroidopathy" 1 => "Pachychoroid" 2 => "Choroidal neovascularisation" 3 => "Optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras claves" "identificador" => "xpalclavsec1341217" "palabras" => array:4 [ 0 => "Paquicoroidopatía peripapilar" 1 => "Paquicoroides" 2 => "Neovascularización coroidea" 3 => "Tomografía de coherencia óptica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A study was made on 8 eyes of 5 patients between 47 and 65 years of age with peripapillary pachychoroidopathy. They all presented with a serous detachment of the neuroepithelium or retinal pigment epithelium in the nasal macular region that extended to the optic disc, with an increase in choroidal thickness at that level. An analysis was made of the choroidal thickness using high penetration optical coherence tomography, as well as their outcome in a period between 12 and 48 months.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Peripapillary pachychoroidopathy is a distinct variant of the pachychoroid disease spectrum. It must be distinguished from other disorders, such as inflammatory or neuro-ophthalmological conditions, that may manifest in the vicinity of the optic disc.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">When faced with a patient with suspected pachychoroidopathy, a specific study of the papillary area should be considered using high penetration optical coherence tomography.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudiamos 8 ojos de 5 pacientes de entre 47 y 65 años de edad con paquicoroidopatía peripapilar. Todos ellos presentaron desprendimiento seroso del neuroepitelio o del epitelio pigmentario de la retina en la región macular nasal que se extendía hacia el disco óptico, con aumento del grosor coroideo a ese nivel. Analizamos el grosor coroideo y la evolución que presentaron a lo largo de entre 12 y 48 meses, mediante tomografía de coherencia óptica de alta penetración.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La paquicoroidopatía peripapilar constituye una variedad dentro del espectro de las enfermedades incluidas dentro de la paquicoroidopatía, que debe ser distinguida de otras entidades que pueden manifestarse en vecindad al disco óptico, como procesos inflamatorios o neuro-oftalmológicos.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Ante un paciente con sospecha de paquicoroidopatía, deberíamos considerar el estudio específico del área papilar mediante tomografía de coherencia óptica de alta penetración.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Vicente JL, Martínez-Borrego AC, Molina-Socola FE, Franco-Ruedas C, Espiñeira Periñán MA, López-Herrero F.. Paquicoroidopatía peripapilar. Arch Soc Esp Oftalmol. 2021;96:157–161.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 686 "Ancho" => 1750 "Tamanyo" => 99020 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. OCT. An increase in choroidal thickness and pachyvessels in the parapapillary region is observed in both eyes together with a parapapillary PED in the RE and a smaller PED in the papillomacular bundle in LE. A dot in the retinography in the parapapillary and macular regions stands out in both eyes, and the irregular hyperfluorescence in the FAG in these areas.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1072 "Ancho" => 1750 "Tamanyo" => 144099 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2. OCT RE. Parapapillary SRL and increased choroidal thickness can be seen at this level. An irregular hyperfluorescence is observed in the papillomacular beam and in the macular zone in the RE in the FAG.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 852 "Ancho" => 1800 "Tamanyo" => 127789 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 3. A) OCT. In this image of both eyes, the pachyvessels (asterisks) are shown more clearly, accompanying the rest of the typical signs already described. B) In the retinography of both eyes, areas of atrophy and hypertrophy of RPE in the macular area can be seen. FAG images reveal irregular parapapillary hyperfluorescence, in papillomacular beam and macular region, with some dots in the hypercapture RE (arrows).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 447 "Ancho" => 1800 "Tamanyo" => 82435 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Case 4. A) OCT LE. Parapapillary SRF with choroidal thickening, pachyvessels and thinning of internal choroidal layers. B) OCT-A of LE, where no signs of neovascularization can be observed.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 937 "Ancho" => 1800 "Tamanyo" => 112451 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Case 5. A) OCT. Parapapillary SRF and thinning of inner choroidal layers in both eyes. B) The irregular parapapillary hyperfluorescence in the angiographic image is highlighted. In LE a post-surgical petaloid macular edema is also observed in late times.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "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" => false "autores" => array:2 [ 0 => "N. Phasukkijwatana" 1 => "K.B. 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