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Punctate inner choroidopathy complicated with exudative neurosensory detachment: A favorable response to treatment with systemic corticosteroids and intravitreal ranibizumab
Coroidopatía punctata interna complicada con desprendimiento neurosensorial exudativo: respuesta favorable al tratamiento con corticoides y ranibizumab intravítreo
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"apellidos" => "Sánchez-Vicente" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669116302155" "doi" => "10.1016/j.oftal.2016.10.012" "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/S0365669116302155?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357941730066X?idApp=UINPBA00004N" "url" => "/21735794/0000009200000007/v1_201706250033/S217357941730066X/v1_201706250033/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Punctate inner choroidopathy complicated with exudative neurosensory detachment: A favorable response to treatment with systemic corticosteroids and intravitreal ranibizumab" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "346" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Roca, M. Menezo, J.M. Ronchera, J.M. Esteban, B. Roca" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Roca" "email" => array:1 [ 0 => "manurocasanz@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Menezo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Ronchera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Esteban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "B." "apellidos" => "Roca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Instituto Oftalmológico JM Menezo, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Castellón, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General de Castellón, Castellón de la Plana, Castellón, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Coroidopatía punctata interna complicada con desprendimiento neurosensorial exudativo: respuesta favorable al tratamiento con corticoides y ranibizumab intravítreo" ] ] "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" => 988 "Ancho" => 1500 "Tamanyo" => 277479 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Image of one of the lesions in OCT.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0010" class="elsevierStylePara elsevierViewall">Punctate inner choroidopathy (PIC) is a multifocal choroiditis without inflammatory signs in the anterior chamber of vitreous. PIC is an infrequent process that generally affects healthy young women. It can evolved toward the formation of chorioretinal scars and choroidal neovascular membranes (CNVM).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">Female, 20, who visited due to scotoma in the central area of the right eye visual field. The patient exhibited myopia without other relevant to ophthalmological or systemic antecedents.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Best corrected visual acuity (BCVA) was 0.7 in the right eye (RE) and 1.0 in the left eye (LE). Exploration of both anterior segments and intraocular pressure gave normal results. RE ocular fundus (OF) examination revealed transparent vitreous and multiple small yellowish lesions in the posterior pole (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A); the OF of the LE did not reveal pathological findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Autofluoresceingraph evidence numerous hypoautofluorescent lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) that, in fluorescein angiography (FAG) showed 3 different patterns: hyperfluorescence from early times, staining in late times and mixed pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The lesions did not exhibit stain losses. Indocyanine green angiography showed lesions as hypofluorescent (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Optical coherence tomography (OCT) showed RE lesions as elevations of the retina pigment epithelium produced by a hyper-reflective material. Some of the lesions exhibited epithelial disruption with photoreceptor layer alteration and underlying hyper-reflectiveness (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Chest X-ray, tuberculin test, toxoplasmosis serology and complete analytics including acute phase reactants, angiotensin conversion enzyme, expanded biochemistry and hemogram produced normal results. Considering patient clinic and test results, the most likely diagnostic was PIC. As apparently the process was not active and no complications could be observed it was decided to refrain from treating, opting for regular checkups.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient remained stable during several visits, but at the fourth month of follow-up the scotoma worsened. BCVA in the RE was of 0.2 while OF showed an image suggesting exudative neurosensory detachment at the macular level (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A) that was confirmed with OCT (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A). FAG showed los of stain in many choroiditis loci as well as stain pooling in the detachment area (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B–D).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Considering the new results, 1<span class="elsevierStyleHsp" style=""></span>mg/kg of weight per day oral prednisone was prescribed in addition to an intravitreal 0.5<span class="elsevierStyleHsp" style=""></span>mg dose of ranibizumab. The checkup 7 days later showed structural and functional improvements, meaning that the fluid had been reabsorbed (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B). BCVA had improved to 0.6. The prednisone dosis was progressively diminished. The patient remained clinically stable without changes in OCT during over one year follow-up.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">PIC is an infrequent process, with only small series and individual cases reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The key clinical findings for diagnosing PIC are the existence of multiple choroiditis loci in the posterior pole and absence of inflammation in the vitreous or anterior chamber. The disease is generally bilateral although symptoms are usually unilateral. In some cases, neurosensory detachment occurs due to the exudation of multiple confluent active lesions as in the present case. PIC can complicate with the development of CNVM, which can also produce subretinal fluid. The authors consider that in this case the detachment probably occurred due to the exudation of the choroiditis loci as the patient did not exhibit neovessels, green-grayish membrane, hemorrhages or other typical neovascularization findings. In addition, contrast leak observed in angiography arose in active choroiditis loci.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,4,5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The differential diagnostic of PIC should include infectious diseases such as histoplasmosis, neoplasias such as lymphoma, inflammatory processes such as sarcoidosis or self-immune diseases like the Vogt–Koyanagi–Harada syndrome. Due to the clinical records of the patient and the normal result of all tests, it was reasonable to discard all of the above diseases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In its active phase, choroiditis is generally treated with corticoids. In the event of relapses, immunomodulators can also be used such as mycophenolate mofetil. Vascular endothelial growth factor antagonists (anti-VEGF), treatment with laser or photodynamic therapy can be useful to treat CNVM. However, cases of other inflammatory ocular diseases complicated with exudative neurosensory detachment without CNVM have been described, in which anti-VEGF have been successfully utilized.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a> For this reason, in the present case it was decided to use ranibizumab at the empirical level.</p><p id="par0080" class="elsevierStylePara elsevierViewall">It would be desirable to have randomized studies evaluating the efficacy of anti-VEGF in similar cases in order to firmly recommend their use. However, the low incidence of this disease makes it virtually impossible to carry out said studies.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors in relation to this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres856936" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec850981" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres856935" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec850980" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-03-02" "fechaAceptado" => "2016-07-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec850981" "palabras" => array:5 [ 0 => "Punctate inner choroidopathy" 1 => "Choroiditis" 2 => "Retinal detachment" 3 => "Angiogenesis inhibitors" 4 => "Ranibizumab" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec850980" "palabras" => array:5 [ 0 => "Coroidopatía punctata interna" 1 => "Coroiditis" 2 => "Desprendimiento de retina" 3 => "Antiangiogénicos" 4 => "Ranibizumab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Punctate inner choroidopathy (PIC) is a variant of multifocal choroiditis that principally affects young and healthy women. A case of this condition is described in a woman who presented with a scotoma as the main complaint. Four months after the diagnosis of PIC, she developed an exudative neurosensory detachment associated with an active focus of juxtafoveal choroiditis. Finally, with systemic corticosteroids and intravitreal ranibizumab, she made excellent progress.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intravitreal ranibizumab, associated with systemic corticosteroids, may be an effective treatment for exudative neurosensory detachment complicating PIC.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La coroidopatía punctata interna (CPI) es una modalidad de coroiditis multifocal que suele afectar a mujeres jóvenes sanas. Describimos un caso de dicha entidad en una paciente que consultó por presentar un escotoma. Cuatro meses después de realizársele el diagnóstico de CPI, desarrolló un desprendimiento neurosensorial exudativo asociado a un foco activo de coroiditis yuxtafoveolar. Finalmente, con corticoides sistémicos y ranibizumab intravítreo presentó una buena evolución.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ranibizumab intravítreo, junto con corticosteroides sistémicos, puede ser un tratamiento efectivo para casos de desprendimiento neurosensorial exudativo que se presentan como complicación de la CPI.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Roca M, Menezo M, Ronchera JM, Esteban JM, Roca B. Coroidopatía punctata interna complicada con desprendimiento neurosensorial exudativo: respuesta favorable al tratamiento con corticoides y ranibizumab intravítreo. Arch Soc Esp Oftalmol. 2017;92:343–346.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1301 "Ancho" => 1500 "Tamanyo" => 218327 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lesions shown in retinography (A), autofluoresceingraph (B), fluorescein angiography (C), and indocyanine green angiography (D).</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" => 988 "Ancho" => 1500 "Tamanyo" => 277479 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Image of one of the lesions in OCT.</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" => 1301 "Ancho" => 1500 "Tamanyo" => 300487 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Neurosensory detachment retinography (A). Stain pooling and leak in fluorescein angiography (B–D).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 486 "Ancho" => 1500 "Tamanyo" => 160734 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Macular OCT prior to treatment, evidencing neurosensory detachment (A), and macular OCT after the resolution of said complication (B) in the present case.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[chapter 76]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "White spot syndromes and related diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.G. 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