PMC8095303_01
Baseline color fundus photo of the right eye showing drop-shaped sub-internal limiting membrane hemorrhage at the fovea (a); fundus fluorescein angiography showing blocked fluorescence confirming the subinternal limiting membrane hemorrhage with otherwise normal findings (b); Indocyanine green showing a hyper-fluorescent nodule at the edge of the blocked fluorescence due to subinternal limiting membrane hemorrhage (c); optical coherence tomography image (taken immediately after the onset of complaints by referring doctor) showing sub-internal limiting membrane hemorrhage with after shadowing and PEDs (d); optical coherence tomography through the fovea showing reducing sub-internal limiting membrane hemorrhage with after-shadowing along with increased sub-retinal fluid and small irregular notched PED (e)
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F1
His medical record and optical coherence tomography (OCT) image (taken immediately after onset of complaints by the referring ophthalmologist) showed the presence of sub-ILM hemorrhage with SRF and pigment epithelial detachments (PEDs) [Figure 1d]. RE was 20/200. RE fundus examination and OCT revealed the presence of foveal sub-ILM hemorrhage, SRF, small irregular notched PEDs, and double-layer sign [Figure 1a and e]. A diagnosis of RE PCV was made based on fundus fluorescein angiography (FFA) and Indocyanine green angiography (ICG) features [Figure 1b-d].
Optical coherence tomography macula 1 month after the 1st injection showing minimal residual sub-internal limiting membrane hemorrhage with resolution of sub-retinal fluid and reduction in size of PED (a); optical coherence tomography image at 1 month after second injection showing the complete resolution of sub-internal limiting membrane hemorrhage and flattening of PED (b); Enhanced depth imaging optical coherence tomography showing thickened choroid with dilated outer choroidal vessels suggestive of pachychoroid (c); Color fundus photo at the final visit showing complete resolution of sub- internal limiting membrane hemorrhage (d)
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F2
One month later, fundus examination and OCT showed a reduction in the sub-ILM hemorrhage, disappearance of SRF, and reduction in the size of PEDs [Figure 2a and d] with BCVA improving to 20/60. At 1 month following second injection, RE BCVA improved to 20/30 with fundus appearing grossly normal and OCT showing near complete resolution of sub-ILM hemorrhage and flattening of PEDs [Figure 2b]. An enhanced-depth imaging (EDI) O OCT done at this stage showed a choroidal thickness of 400mu in the RE suggestive of pachychoroid [Figure 2c].
PMC8095303_02
Color fundus photo of the left eye showing the hemorrhagic PED (black arrow) and sub-internal limiting membrane hemorrhage (white arrow) (a); Early and late phases of Indocyanine green angiogram showing blocked fluorescence due to the haemorrhagic PED (b and c); optical coherence tomography images at presentation showing hemorrhagic PED with after shadowing, thick choroid with dilated outer choroidal vessels and sub-internal limiting membrane hemorrhage (d and e); optical coherence tomography images at 1 month postinjection shows the reduction in size of hemorrhagic PED and disappearance of sub-internal limiting membrane hemorrhage (f and g)
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F3
LE showed hemorrhagic PED at the fovea and sub-ILM hemorrhage at inferonasal macula [Figure 3a and d]. LE EDI-OCT confirmed the presence of pachychoroid in the BE [Figure 3d]. ICG did not reveal any hyperfluorescence in the LE due to masking by the hemorrhagic PED [Figure 3b and c]. Fundus examination revealed the disappearance of sub-ILM hemorrhage with a reduction in the size of hemorrhagic PED which were confirmed on OCT [Figure 3e-g].