Urrets-Zavalia Julio A, Crim Nicolas, Esposito Evangelina, Correa Leandro, Gonzalez-Castellanos M Eugenia, Martinez Dana
Department of Ophthalmology, University Clinic Reina Fabiola, Universidad Catolica de Cordoba, Cordoba, Argentina.
Clin Ophthalmol. 2015 Mar 6;9:455-9. doi: 10.2147/OPTH.S80152. eCollection 2015.
To present a case of a complicated posterior melanocytoma that was successfully treated with intravitreal bevacizumab.
A 50-year-old Caucasian man was referred with sudden-onset metamorphopsia and decreased vision in his right eye over the course of the last 2 months. His best-corrected visual acuity was 20/80 and poorer than Jaeger 14 in the right eye, and 20/20 and Jaeger 1 in his left eye. In the right fundus, there was a melanocytic lesion occupying the inferotemporal quadrant of the optic disk, extending to the adjacent choroid inferiorly; optic nerve edema, superotemporal retinal vein dilatation, and subretinal fluid under the macula and nasal half of the posterior pole were observed, and a subretinal choroidal neovascularization complex was observed adjacent to the superotemporal margin of the optic disk, confirmed by fluorescein angiography, surrounded by a dense subretinal hemorrhage. Optical coherence tomography showed retinal edema and detachment of neurosensory retina. The patient was treated with three consecutive doses on a monthly basis of intravitreal 1.25 mg/0.05 mL bevacizumab. Visual acuity recovered rapidly, and at 4 months after treatment, it was 20/20 and Jaeger 1, with complete resolution of macular edema and subretinal fluid and hemorrhage. After 3 years of follow-up, best-corrected visual acuity remained stable, macular area was normal, and there was no evident optic nerve edema, retinal vein caliber and aspect were normal, and there was no significant change of the tumor. Fluorescein angiography only evidenced late staining of choroidal neovascularization scar, and optical coherence tomography showed a normal macular anatomy.
Intravitreal bevacizumab was effective in the treatment of choroidal neovascularization, optic nerve edema, venous dilatation, and local capillary telangiectasia, complicating an optic disk melanocytoma.
报告1例采用玻璃体内注射贝伐单抗成功治疗的复杂性视盘黑色素细胞瘤病例。
一名50岁的白种男性在过去2个月内右眼突然出现视物变形和视力下降，遂前来就诊。其右眼最佳矫正视力为20/80，低于耶格视力表14级；左眼最佳矫正视力为20/20，耶格视力表1级。右眼眼底可见一个黑色素细胞病变，占据视盘颞下象限，并向下延伸至相邻脉络膜；可见视神经水肿、颞上视网膜静脉扩张、黄斑及后极部鼻侧一半的视网膜下液，且在视盘颞上缘附近可见一个视网膜下脉络膜新生血管复合体，荧光素血管造影证实该复合体周围有密集的视网膜下出血。光学相干断层扫描显示视网膜水肿及神经感觉层视网膜脱离。该患者每月连续3次接受玻璃体内注射1.25 mg/0.05 mL贝伐单抗治疗。视力迅速恢复，治疗4个月后，视力为20/20，耶格视力表1级，黄斑水肿、视网膜下液及出血完全消退。随访3年后，最佳矫正视力保持稳定，黄斑区正常，无明显视神经水肿，视网膜静脉管径及外观正常，肿瘤无明显变化。荧光素血管造影仅显示脉络膜新生血管瘢痕的晚期染色，光学相干断层扫描显示黄斑解剖结构正常。
玻璃体内注射贝伐单抗可有效治疗视盘黑色素细胞瘤合并的脉络膜新生血管、视神经水肿、静脉扩张及局部毛细血管扩张。
