Title

RANIBIZUMAB FOR BILATERAL AND SIMULTANEOUS SUBFOVEAL CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH STARGARDT’S DISEASE

Introduction

Stargardt’s disease is a hereditary disease characterized by the progressive accumulation of lipofuscin in the cells of the retinal pigment epithelium (RPE) and photoreceptor layer, causing progressive degeneration of these and consequently visual acuity impairment. Choroidal neovascularization (CNV) is a rare complication in Stargardt’s disease, although there are reports of occurrence in up to 2% of patients. CNV is associated with a rapid progression and poor visual prognosis. The purpose of this report is to describe a case of Stargardt macular dystrophy complicated with bilateral choroidal neovascularization which underwent treatment with an intravitreal ranibizumab injection.

Methods

Case report was documented with complete oplthamologic examination, including autofluorescence, spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT-A).

Results

A 76-year-old woman with Stargardt disease presented with CNV in both eyes simultaneously. Best-corrected visual acuity was 20/250 in the right eye and 20/40 in the left eye. The treatment chosen for both eyes was intravitreal ranibizumab, due to the subfoveal location of the CNV. After only one injection, the patient showed visual improvement.

Discussion

Nowadays, there are some possible treatmentes described in literature for CNV secondary to retinal dystrophies, including photodynamic therapy and laser therapy, but with poor results. In the presented case, the patient achieved a visual acuity improvement in the first application of ranibizumab. Although great inicial improvement in visual acuity, more time is needed to evaluate the effect of anti-VEGF in our patient.

Keywords

Choroidal neovascularization, ranibizumab, Stargardt disease.

Area

CLINICAL CASE

Authors

Keylla Oliveira, Luiza Souza, Cecilia Santos, Samuel Magalhães, Marcela Leite, André Príncipe, Diana Abreu