case_images: PMC4327404_01
case_images: a At baseline presentation, the macula of the left eye demonstrates focal hemorrhages and edema (arrow 1). b FA reveals active leakage from a small classic CNV lesion (arrow 2). c SD-OCT shows subretinal fluid (arrow 3), focal hyperreflective material above the retinal pigment epithelium (arrow 4) and RPE detachment (arrow 5). d Following the third intravitreal injection with ranibizumab, anatomical improvement with resolution of subretinal fluid is seen. In SD-OCT, a focal RPE scar (arrow 6) and a persistent RPE detachment (arrow 7) are seen.
case_images: cop-0006-0018-g01.jpg
case_images: PMC4327404_01_cop-0006-0018-g01.jpg
case_images: F1
case_images: Ophthalmoscopy revealed subretinal fluid and focal hemorrhage in the macula of the left eye (fig. 1a). A fluorescein angiography (FA) showed a hyperfluorescent lesion with well-defined borders and active leakage consistent with classic CNV (fig. 1b). A spectral domain OCT [SD-OCT; Spectralis OCTTM (Heidelberg Engineering, Heidelberg, Germany)] revealed subretinal fluid and focal hyperreflective material in the subretinal space as well as an area with small retinal pigment epithelium (RPE) detachments (fig. 1c). After this loading dose, her BCVA improved to 20/25 in the left eye, and there also was a marked anatomical improvement (fig. 1d).
case_images: a Two years later, FA identifies two active leakage sites temporal and inferior to the fovea (arrows 1 and 2). b Indocyanine green angiography reveals 2 separate hot spots, temporal and inferior to the fovea (arrows 3 and 4). c SD-OCT detects subretinal fluid (arrow 5) and an enlarged area with RPE irregularities and RPE detachment (arrow 6), intraretinal cysts (arrow 7) and hyperreflective subretinal material (arrow 8). d SD-OCT following successful treatment with ranibizumab injections shows persistent small intraretinal cysts (arrow 9) and a fibrovascular RPE detachment temporal to the fovea (arrow 10).
case_images: cop-0006-0018-g02.jpg
case_images: PMC4327404_01_cop-0006-0018-g02.jpg
case_images: F2
case_images: Indocyanine green angiography revealed focal hot spots in these areas (fig. 2a, b). SD-OCT showed marked subretinal fluid, an increased extension of RPE detachments and RPE discontinuity, discrete intraretinal cysts and hyperreflective subretinal material (fig. 2c). The BCVA improved to 20/25, but there was persistence of fibrovascular RPE detachment (fig. 2d).