Coriorretinopatia Serosa Central: Resultados a Longo Prazo Após Terapia Fotodinâmica

Autores

  • Pedro Nuno Sousa Pereira Centro Hospitalar e Universitário de Coimbra
  • Sofia Catalão Ferreira University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal
  • Mário Soares Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal;
  • Pedro Melo Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal;
  • Cláudia Farinha Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
  • João Pedro Marques Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
  • Isabel Pires Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
  • Maria Luz Cachulo Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
  • Joaquim Murta Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
  • Rufino Silva Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

DOI:

https://doi.org/10.48560/rspo.25892

Palavras-chave:

Coriorretinopatia Serosa Central/tratamento farmacológico, Fotoquimioterapia, Verteporfina/uso terapêutico

Resumo

Introdução: A coriorretinopatia serosa central (CSC) é uma síndrome idiopática caracterizada por descolamentos serosos da retina. O desenvolvimento de CSC crónica é uma indicação para tratamento e a terapia fotodinâmica com verteporfina guiada por ICGA tem-se revelado muito eficaz.

O nosso objectivo foi avaliar a eficácia e segurança da TFD standard com verteporfina, durante um período de seguimento de 13 anos, descrevendo as alterações microestruturais e vasculares a longo prazo.

Métodos: Procedeu-se a um estudo retrospetivo de doentes com CSC crónica, tratados com TFD standard. As avaliações periódicas foram realizadas a cada 3 meses no primeiro ano, cada 6 meses no segundo e, posteriormente, anualmente. Todos os participantes realizaram um exame oftalmológico completo. A imagiologia da retina e da coróide foi obtida recorrendo a abordagem multimodal com SD-OCT, SS-OCT, Optomap e OCTA.

Resultados: Foram incluídos 23 olhos de 18 doentes, com uma idade média de 63,9±8,5 anos. O período médio de follow-up foi 15,8±1,4 anos. O número médio de tratamentos de TFDs foi de 1,2±1,4. No início do estudo, o fluído subretiniano estava presente em todos os olhos, a proliferação do EPR em 9,1% e atrofia em 9,1% dos olhos. Não se observou melhoria estatisticamente significativa na MAVC, apesar de um ganho médio inicial de 5,08±10,36 letras no 12º mês (p<0,05), que diminuiu para 1,87±11,9 letras no final do seguimento. Na visita final, apenas 3 olhos apresentavam fluído subretiniano, 3 demonstravam fibrose e 15 (65,2%) apresentavam atrofia. A espessura macular central reduziu de 340,7±114,9 µm para 228,7±38,6 no final do seguimento (p<0,05). A coróide dos olhos tratados era mais espessa, mas a coriocapilar apresentava menor fluxo vascular em comparação com olhos não tratados. Apenas uma sessão de TFDs foi necessária em 19 olhos e 4 realizaram duas sessões.

Conclusão: A TFD standard guiada por ICGA é um procedimento seguro, sem efeitos adversos graves oculares ou sistémicos. Após 13 anos, apenas 17,4% dos casos necessitaram de 2 sessões. Porém, dois terços dos casos apresentaram atrofia na última consulta, o que provavelmente está relacionado com a progressão das alterações degenerativas da doença, limitando a melhoria da acuidade visual a longo prazo.

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Publicado

2021-12-31

Como Citar

Sousa Pereira, P. N., Ferreira, S. C., Soares, M., Melo, P., Farinha, C., Marques, J. P., Pires, I., Cachulo, M. L., Murta, J., & Silva, R. (2021). Coriorretinopatia Serosa Central: Resultados a Longo Prazo Após Terapia Fotodinâmica. Revista Sociedade Portuguesa De Oftalmologia, 45(4), 187–194. https://doi.org/10.48560/rspo.25892

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