Visudyne

Demographics

* Age range at presentation: Young to middle-aged

* Gender trends: Increased prevalence in men

* Racial trends: Increased incidence in Asian and Indian patients

* Refractive error trends: None

* Associated medical conditions: Strong association with pregnancy, type A personality, exogenous glucocorticoids and Gushing disease

Symptoms

* Sudden onset of central scotoma, micropsia, metamorphopsia, color desaturation and unilateral blurred vision.

* Moderately decreased visual acuity that is improved with a small hyperopic correction.

* Often temporally related to major life stressor.

Differential Diagnosis

* Age-related macular degeneration (AMD): Drusen, the hallmark of AMD, are absent in CSC. Patients with AMD present at an older age and may have accompanying clinical signs of choroidal neovascularization (CNV), particularly blood.

* Inflammatory chorioretinopathy. This condition is more likely to occur in young myopes and may be accompanied by the presence of cells in the anterior chamber and vitreous, vascular sheathing and exudation.

Systemic symptoms often include headaches, malaise and skin changes.

* Idiopathic polypoidal choroidal vasculopathy: This is most often seen in more pigmented races and may be indistinguishable from CNV in some cases.

Significant subretinal bleeding is a typical feature of this condition.

Manifestations

Active Disease

The presence of serous detachment of the sensory retina and retinal pigment epithelial detachment (small, round, yellowishgray spots of variable size best seen on fluorescein angiography) are noted.

Management: Argon laser photocoagulation directed at the choriocapillaris leakage hastens recovery; but evidence that it reduces disease sequelae or frequency of relapse is inconclusive.

The decision to treat should be based on presence of symptoms, duration of disease and condition of the fellow eye.

Referral to a retinal specialist for angiography and possible treatment is advised to limit long-term vision loss.

Prognosis: Eighty percent of eyes undergo spontaneous resorption of subretinal fluid, with recovery in visual acuity within 6 months.

Some patients may be left with a mild permanent defect, such as scotoma, decreased color sensitivity or micropsia.

Centrally located retinal pigment epithelial (RPE) elevation.

Twenty percent of patients will have one or more recurrences of the disease and complications, such as subretinal neovascularization and chronic cystoid macular edema.

Inactive/Chronic Disease

In the more chronic disease state, atrophie changes, chronic retinal elevation, pigment hyperplasia, lipid and gravitating tracks of subretinal fluid may occur.

Management: Large clinical trials still have not produced a treatment that reduces choroid leakage in chronic disease.

Recent pilot trials suggest photodynamic therapy with verteporfin (Visudyne) may be of some benefit in these cases.

Referral to a retinal specialist for angiography and possible treatment is advised to limit long-term vision loss.

Copyright Boucher Communications, Inc. Sep 2005
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