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Br J Ophthalmol. 2019 Oct 23. pii: bjophthalmol-2018-313307. doi: 10.1136/bjophthalmol-2018-313307. [Epub ahead of print]

Diagnosis and treatment of peripheral exudative haemorrhagic chorioretinopathy.

Author information

1
Department of Ophthalmology, Pasteur 2 University Hospital, Nice, France.
2
Department of Ophthalmology, Galien Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France.
3
Department of ophthalmology, Centre d'Ophtalmologie Monticelli-Paradis, Marseille, France.
4
Department of Ophthalmology, Centre d'imagerie et de Laser, Paris, France.
5
Department of ophthalmology, Lariboisière University Hospital, Paris, France.
6
Department of Ophthalmology, Pasteur 2 University Hospital, Nice, France maschi.c@chu-nice.fr.
7
Department of ophthalmology, A. de Rothschild Ophthalmologic Foundation, Paris, France.
8
Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.
9
Department of ophthalmology, Oxford Clinic, Cannes-Juan-les-pins, France.
10
Department of radiotherapy, Centre François Baclesse / ARCHADE, Caen, France.

Abstract

PURPOSE:

Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a rare disorder that is often misdiagnosed. The aim of this study was to better characterise PEHCR and to assess treatment options.

MATERIAL AND METHODS:

Retrospective multicentric chart review.

RESULTS:

Of 84 eyes (69 patients) with PEHCR referred between 2005 and 2017, the most common referral diagnosis was choroidal melanoma (41.3%). Bilateral involvement was found in 21.7% of cases. Haemorrhagic retinal pigment epithelium detachment was the most common peripheral lesion (53.6%). Maculopathy was associated with peripheral lesions in 65.8% of cases. PEHCR lesions were mostly heterogeneous (58.8%) on B-scan ultrasonography. Choroidal neovascularisation was found in 10 eyes (26.3%) out of 38 eyes that underwent fluorescein angiography. Polyps were observed in 14 eyes (58.3%) out of 24 eyes that underwent indocyanine green angiography. Fifty-one eyes were treated (62.2%). Intravitreal injections (IVTI) of antivascular endothelial growth factor (VEGF) were the most used treatment (36.6%) before laser photocoagulation, photodynamic therapy, vitrectomy and cryotherapy. Only vitrectomy improved visual acuity. Most lesions (65.6%) regressed at the last follow-up visit.

CONCLUSION:

In case of PEHCR, multimodal imaging is useful to avoid misdiagnosis, to characterise PEHCR lesions and to guide treatment strategies. Regression of PEHCR lesions was observed in two-thirds of the patients. Vitrectomy improved visual acuity. More than a third of patients underwent anti-VEGF IVTI. Further studies are needed to assess IVTI's efficacy.

KEYWORDS:

angiography; imaging; peripheral exudative hemorrhagic chorioretinopathy; treatment; ultrasonography; visual acuity

Conflict of interest statement

Competing interests: None declared.

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