Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment
Purpose: To present a distinctive case of polypoidal choroidal vasculopathy (PCV) with an exceptionally elevated pigment epithelial detachment (PED). Observations: We describe the case of a 48-year-old African-American woman who presented with a substantial lesion in the right eye. Fundus examinatio...
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Elsevier
2024-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993624001816 |
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| author | Yanliang Li Hesham Gabr William F. Mieler |
| author_facet | Yanliang Li Hesham Gabr William F. Mieler |
| author_sort | Yanliang Li |
| collection | DOAJ |
| description | Purpose: To present a distinctive case of polypoidal choroidal vasculopathy (PCV) with an exceptionally elevated pigment epithelial detachment (PED). Observations: We describe the case of a 48-year-old African-American woman who presented with a substantial lesion in the right eye. Fundus examination revealed an exceptionally elevated lesion extending in the inter-papilla-macular region with multiple dark pigmented spots. Indocyanine Green Angiography (ICGA) in the early phase displayed focal hyperfluorescent spots and a blockage of fluorescence within the lesion, particularly overlying the papillomacular bundle. In the late phase, hyperfluorescent spots within the lesion became evident, with a hyperfluorescent outline of the lesion indicating vascularization. Optical coherence tomography in the right eye disclosed an exceptionally elevated PED temporal to the optic nerve with an elevation of more than 2500 μm, along with subretinal fluid and trace intraretinal fluid. Conclusions and importance: Multimodal imaging unveiled an atypical case of PCV featuring an exceptionally extensive polypoidal lesion overlying the papillomacular bundle with choroidal neovascularization. Given the presence of a highly conspicuous, elevated PED, it was felt that the risk of retinal pigment epithelium tear was high either with anti-VEGF therapy or even due to natural history. In this scenario, the initial treatment choice was photodynamic therapy rather than intravitreal anti-VEGF injection, which led to complete regression with excellent visual acuity. |
| format | Article |
| id | doaj-art-1d571e86fb5f4d3f950f8c23a8f5e92a |
| institution | Kabale University |
| issn | 2451-9936 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj-art-1d571e86fb5f4d3f950f8c23a8f5e92a2024-12-18T08:50:39ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362024-12-0136102171Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachmentYanliang Li0Hesham Gabr1William F. Mieler2Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USADepartment of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USACorresponding author.; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USAPurpose: To present a distinctive case of polypoidal choroidal vasculopathy (PCV) with an exceptionally elevated pigment epithelial detachment (PED). Observations: We describe the case of a 48-year-old African-American woman who presented with a substantial lesion in the right eye. Fundus examination revealed an exceptionally elevated lesion extending in the inter-papilla-macular region with multiple dark pigmented spots. Indocyanine Green Angiography (ICGA) in the early phase displayed focal hyperfluorescent spots and a blockage of fluorescence within the lesion, particularly overlying the papillomacular bundle. In the late phase, hyperfluorescent spots within the lesion became evident, with a hyperfluorescent outline of the lesion indicating vascularization. Optical coherence tomography in the right eye disclosed an exceptionally elevated PED temporal to the optic nerve with an elevation of more than 2500 μm, along with subretinal fluid and trace intraretinal fluid. Conclusions and importance: Multimodal imaging unveiled an atypical case of PCV featuring an exceptionally extensive polypoidal lesion overlying the papillomacular bundle with choroidal neovascularization. Given the presence of a highly conspicuous, elevated PED, it was felt that the risk of retinal pigment epithelium tear was high either with anti-VEGF therapy or even due to natural history. In this scenario, the initial treatment choice was photodynamic therapy rather than intravitreal anti-VEGF injection, which led to complete regression with excellent visual acuity.http://www.sciencedirect.com/science/article/pii/S2451993624001816Polypoidal choroidal vasculopathyPigment epithelial detachmentRetinal pigment epithelium tear |
| spellingShingle | Yanliang Li Hesham Gabr William F. Mieler Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment American Journal of Ophthalmology Case Reports Polypoidal choroidal vasculopathy Pigment epithelial detachment Retinal pigment epithelium tear |
| title | Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment |
| title_full | Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment |
| title_fullStr | Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment |
| title_full_unstemmed | Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment |
| title_short | Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment |
| title_sort | polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment |
| topic | Polypoidal choroidal vasculopathy Pigment epithelial detachment Retinal pigment epithelium tear |
| url | http://www.sciencedirect.com/science/article/pii/S2451993624001816 |
| work_keys_str_mv | AT yanliangli polypoidalchoroidalvasculopathywithanexceptionallyelevatedpigmentepithelialdetachment AT heshamgabr polypoidalchoroidalvasculopathywithanexceptionallyelevatedpigmentepithelialdetachment AT williamfmieler polypoidalchoroidalvasculopathywithanexceptionallyelevatedpigmentepithelialdetachment |