Keidel Leonie F, Schworm Benedikt, Priglinger Siegfried G, Siedlecki Jakob
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Case Rep Ophthalmol. 2021 Apr 9;12(1):116-123. doi: 10.1159/000510828. eCollection 2021 Jan-Apr.
Nonresponse of neovascular age-related macular degeneration (nAMD) to anti-vascular endothelial growth factor (anti-VEGF) therapy can often be attributed to misdiagnosis, and pathologies mimicking AMD might require different therapeutic concepts. In the following, we want to outline a case of presumed nAMD which revealed to be pachychoroid neovasculopathy (PNV) and was successfully treated by the addition of spironolactone. A 67-year-old female patient was referred for nonresponse of nAMD on her left eye after 29 intravitreal injections of aflibercept with no complete resolution of subretinal fluid. On fundoscopy, both maculae presented with pigment epithelium alterations, while the left eye showed subretinal fluid on optical coherence tomography (OCT) with an associated pigment epithelium detachment, which revealed to contain a neovascular network on OCT angiography. There was faint leakage on fluorescence (FAG) and indocyanine green angiography (ICGA) and some focal vascular dilation of the neovascular network on ICGA. Due to the absence of Drusen on any eye, a thick choroid, and the presence of a gravitational tract on blue autofluorescence (BAF), chronic central serous chorioretinopathy with a choroidal neovascularization, defined as PNV in the pachychoroid disease was diagnosed. Upon the addition of spironolactone to anti-VEGF treatment, choroidal thickness significantly decreased, and subretinal fluid resolution was observed and maintained for the first time. In conclusion, PNV should be ruled out in cases of presumed nAMD nonresponding to anti-VEGF. In these cases, a combination therapy of anti-VEGF and mineralocorticoid antagonists can facilitate fluid resorption.
新生血管性年龄相关性黄斑变性（nAMD）对抗血管内皮生长因子（anti-VEGF）治疗无反应通常可归因于误诊，而模仿AMD的病理情况可能需要不同的治疗理念。在此，我们想概述一例疑似nAMD的病例，结果显示为厚脉络膜新生血管病变（PNV），并通过加用螺内酯成功治疗。一名67岁女性患者在左眼接受29次玻璃体内注射阿柏西普后，因nAMD无反应前来就诊，视网膜下液未完全消退。眼底检查时，双眼黄斑均有色素上皮改变，而左眼在光学相干断层扫描（OCT）上显示视网膜下液并伴有色素上皮脱离，在OCT血管造影上显示其中含有一个新生血管网络。荧光素血管造影（FAG）和吲哚菁绿血管造影（ICGA）有轻微渗漏，ICGA上新生血管网络有一些局灶性血管扩张。由于任何一只眼睛均无玻璃膜疣、脉络膜增厚以及蓝色自发荧光（BAF）上存在重力线，诊断为慢性中心性浆液性脉络膜视网膜病变伴脉络膜新生血管形成，在厚脉络膜疾病中定义为PNV。在抗VEGF治疗中加用螺内酯后，脉络膜厚度显著降低，首次观察到并维持了视网膜下液的消退。总之，在疑似nAMD对抗VEGF无反应的病例中应排除PNV。在这些病例中，抗VEGF和盐皮质激素拮抗剂的联合治疗可促进液体吸收。
