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Anales de la Sociedad Mexicana de Oftalmología y Archivos de la Asociación Para Evitar la Ceguera en México

2018, Número 4

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Rev Mex Oftalmol 2018; 92 (4)


Terapia fotodinámica combinada con bevacizumab intravítreo para el tratamiento de la neovascularización coroidea refractaria al tratamiento con monoterapia con bevacizumab. Una serie de casos

García-Aguirre G, Romo-Aguas JC, Santos-Palacios A, Henaine-Berra A, Vélez-Montoya R, Fromow-Guerra J

Idioma: Español
Referencias bibliográficas: 25
Paginas: 180-186
Archivo PDF: 461.34 Kb.


RESUMEN

Propósito: Evaluar la respuesta clínica de la terapia fotodinámica (TFD) combinada con bevacizumab intravítreo (BVZ) en neovascularizaciones coroideas (NVC) resistentes al tratamiento. Métodos: Evaluación retrospectiva, no comparativa, de ojos con diagnóstico de NVC secundaria a degeneración macular relacionada con la edad sin respuesta clínica después de al menos 3 inyecciones intravítreas de BVZ, a los que se administró TFD+BVZ combinados y posteriormente BVZ mensual durante un periodo de 6 meses. Las variables principales de desenlace incluyeron agudeza visual corregida (AVC) y grosor macular central (GMC) durante un seguimiento de 6 meses posteriores al tratamiento combinado. Resultados: Se incluyeron once pacientes (54.5% femenino, media de edad 62 años). Utilizando angiografía con ICG, las lesiones se clasificaron como vasculopatía coroidea polipoidea (VCP) en 54.4%, NVC arteriolizada en 18.2% (2) y no diferenciable en 27.3% (3). La AVC (logMAR) en la basal fue de 0.63 (20/85), mejorando a 0.32 (20/40) después del tratamiento (p = 0.04). La media de GMC antes de la intervención fue de 469 µm, mejorando a 289 µm seis meses después del tratamiento (p = 0.01). Conclusión: La terapia combinada con TFD+BVZ parece ser efectiva en casos de NVC resistentes a tratamiento, con mejoría de la AVC y el GMC después de un periodo de 6 meses de tratamiento que no se observó con la monoterapia con BVZ. En este grupo se observó una alta incidencia de VCP y NVC arteriolizada o casos de NVC resistentes al tratamiento. La adecuada clasificación del tipo de NVC asociada a una elevada resistencia puede ser útil para el tratamiento.


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