MANAGEMENT OF PERIFOVEAL EXUDATIVE VASCULAR ANOMALOUS COMPLEX.

Abstract

Purpose: To report a case of a patient with perifoveal exudative vascular anomalous complex (PEVAC) and to analyze morphologic and vascular changes by optical coherence tomography (OCT) and OCT angiography (OCTA) before and after treatment.

Materials and methods: The authors reported a case that received multiple treatments for unresponsive effect to repeated aflibercept intravitreal injections, subthreshold micropulse laser therapy duty cycle 5%. At last, the focal full-dose yellow laser was performed.

Results: A 57-year-old male patient presented with best-corrected visual acuity (BCVA) of 20/50 in his right eye (RE). The fundoscopic evaluation, structural OCT, and OCTA deposed for a diagnosis of PEVAC. The patient underwent three aflibercept intravitreal injections in the RE. Because no changes were detected, the authors opted for multiple sessions of yellow subthreshold micropulse laser therapy duty cycle 5%; however, no signs of regression were registered. Only after a full-dose yellow laser, signs of edema regression were observed. Structural OCT B-scan showed complete restoration of retinal profile, in the absence of any intraretinal or subretinal fluid and PEVAC lesion, whereas the OCTA showed a slight flow deficit at the previous lesion site.

Conclusion and importance: The PEVAC treatment is still unknown. In their experience, the authors reported a case of multiple treatments for unresponsive effect to aflibercept intravitreal injections, subthreshold micropulse laser therapy duty cycle 5%. The focal full-dose yellow laser was the only effective treatment in this patient. The authors proposed the management to share the heterogeneous response at PEVAC entity.