Buonamassa Rosa, Palumbo Francesca, Boscia Giacomo, Scotti Giacomo, Ferrara Andrea, De Vitis Fabio, Pignataro Mariagrazia, Termite Alba Chiara, Landini Luca, Alessio Giovanni, Boscia Francesco, Viggiano Pasquale
Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Italy.
Eur J Ophthalmol. 2025 Jan;35(1):NP50-NP53. doi: 10.1177/11206721241291100. Epub 2024 Oct 15.
To present a case of autosomal recessive bestrophinopathy (ARB) complicated by intraretinal fluid and subretinal fluid, successfully managed with navigated subthreshold micropulse laser (SML) treatment.
A 25-year-old female was referred to our clinic by her ophthalmologist due to a diagnosis of reduced vision in both eyes. The patient presented with a visual acuity of 0.9 logMAR in both eyes. Structural optical coherence tomography (OCT) revealed bilateral intraretinal fluid (IRF) and subretinal fluid (SRF), while OCT angiography (OCT-A) demonstrated bilateral macular neovascularization (MNV). Following the initiation of intravitreal therapy with anti-VEGF agents, administered via monthly injections for one year, we observed no improvement in visual acuity or resolution of IRF and SRF. SML treatment was administered to both eyes in the macular region. At the 3-month follow-up visit, OCT revealed complete resolution of IRF in the right eye and partial resolution of IRF in the left eye, and best-corrected visual acuity (BCVA) improved from 0.9 logMAR to 0.7 logMAR.
In our case, SML emerges as a promising treatment modality for patients with ARB complicated by MNV who exhibit poor response to anti-VEGF therapy. However, further prospective studies with longer follow-up periods and larger cohorts are warranted to confirm the optimal treatment strategy in ARB.
报告1例常染色体隐性遗传性Bestrophin病（ARB）合并视网膜内液和视网膜下液，经导航阈下微脉冲激光（SML）治疗成功的病例。
一名25岁女性因双眼视力下降被眼科医生转诊至我院。患者双眼视力为0.9 logMAR。结构光学相干断层扫描（OCT）显示双侧视网膜内液（IRF）和视网膜下液（SRF），而OCT血管造影（OCT-A）显示双侧黄斑新生血管（MNV）。在用抗VEGF药物进行玻璃体内治疗后，每月注射一次，持续一年，我们观察到视力没有改善，IRF和SRF也没有消退。对双眼黄斑区进行了SML治疗。在3个月的随访中，OCT显示右眼IRF完全消退，左眼IRF部分消退，最佳矫正视力（BCVA）从0.9 logMAR提高到0.7 logMAR。
在我们的病例中，对于合并MNV且对抗VEGF治疗反应不佳的ARB患者，SML是一种有前景的治疗方式。然而，需要进一步进行更长随访期和更大样本量的前瞻性研究，以确定ARB的最佳治疗策略。
