Título / Title

RECURRENT MACULAR EDEMA IN VENOUS STASIS RETINOPATHY: CASE REPORT

Introdução / Purpose

To report a case and discuss the topic.

Material e Método / Methods

C.C.M., 83 years old, male, married, retired. Reports loss of OD vision for many years due to retinal ischemia (SIC) and currently complains of sudden low visual acuity in the OS. Patient with glaucoma, using Timolol Maleate 0.5% 2x / day and chronic smoker. Deny other comorbidities. Visual acuity OD: no light perception and OS with correction: 20/60; Biomicroscopy OD: cataract; OS: pseudofacia. Fundoscopy OS: multiple rounded hemorrhages arranged by the posterior pole, arterial narrowing, venous dilatation without tortuosity and attenuation of foveal brightness. Fluorescein angiography OS: increased arm-retina time, slowing of arteriovenous transition, areas of hypofluorescence by blockade corresponding to bleeding. Doppler ultrasonography of carotid arteries revealed the presence of atheroma plaques causing stenosis of less than 50% bilateral. OCT (OS): macular edema.

Resultados / Results

Intravenous injection of Bevacizumab (Avastin) was given in a monthly dose for three months. After 1 month of the last injection the patient evolved with improvement of visual acuity and edema. However, there was return of subretinal fluid during follow-up, which implied a need for a fourth Avastin injection and replacement for Ranibizumab (Lucentis) in a fifth injection. The patient is currently being followed up with periodic OCT, but persists with recurrent macular edema.

Discussão e Conclusões / Conclusion

The main objective of ocular management is to treat the complications of ischemic ocular syndrome, especially in the posterior segment. Regarding the treatment of ongoing macular edema, studies try to prove the efficacy of intra-vitreous use of corticosteroids and anti-angiogenic agents. One may choose to start treatment with intra-vitreous injection of anti-VEGF (endothelial growth factor) to supplement or to help the treatment of choice, panretinal photocoagulation.

Palavras Chave

Ocular schemic syndrome, macular edema.