PMC8102944_01
Multimodal imaging of the right eye at the first presentation. (a) Infrared reflectance and optical coherence tomography (OCT) of the macula and (b) fundus photograph show a large pigment epithelial detachment (PED) at the macula with surrounding small and intermediate drusen. There was a small satellite PED which coalesced into a single large PED 6 days later. (c) Enhanced-depth imaging OCT scan through the foveal center shows a large PED with serous subretinal fluid at its apex
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F1
A large serous PED of 4-disc diameter in size without hemorrhage was found in the right macula [Figure 1].
Fluorescein angiography of the right eye shows pooling hyperfluorescence of the pigment epithelial detachment (PED). Hyperfluorescence was more intense at the inferotemporal area and gradually diffused through the residual area of the PED. There was some late dye leakage into subretinal fluid in the area of foveal avascular zone
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F2
FFA (Spectralis ) showed hyperfluorescence pooling of the serous PED and some leakage into the SRF at the apex of the serous PED [Figure 2].
Indocyanine green angiography (ICGA) of the right eye shows hypocyanescence blockage of the pigment epithelial detachment (PED). There was choroidal hyperpermeability surrounding the PED in the mid to the late phase of the ICGA. No evidence of choroidal neovascularization was identified
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F3
ICGA (Spectralis ) showed choroidal hyperpermeability surrounding the serous PED without any evidence of choroidal neovascularization (CNV) or polyps seen [Figure 3].
Evolution of the pigment epithelial detachment (PED) and subretinal fluid (SRF) of the patient. (a) Baseline enhance-depth imaging optical coherence tomography. (b) 1 month after the first intravitreal injection (bevacizumab), the PED was partially resolved, but SRF increased. (c) 1 month after the second injection (aflibercept), partial resolution of both PED and SRF is shown. (d) 1 month after the third injection (aflibercept), both PED and SRF were completely resolved. The patient's visual acuity improved to 20/30
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F4
The serous PED and SRF were dramatically resolved, and her vision improved to 20/30 [Figure 4].
Multimodal imaging of the right eye at the first relapse of the pigment epithelial detachment (PED). (a) Fundus photograph, (b) infrared image, and (c) enhance-depth imaging optical coherence tomography show a relapse of shallow serous PED without subretinal fluid. (d) Fundus fluorescein angiography demonstrates the pooling of the PED beginning at the inferotemporal area. (e) Indocyanine green angiography shows hypocyanescence blockage of the PED. No abnormal hypercyanescence plaque of choroidal neovascularization was identified. The choroidal hyperpermeability was less intense than at the baseline visit
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F5
FFA and ICGA did not reveal any signs of CNV or polyps despite the fact that the obscuration by the shallow PED was minimal [Figure 5].
Optical coherence tomography angiography when the pigment epithelial detachment (PED) was completely resolved (2 months after the fourth intravitreal injection). There was no sign of abnormal neovascularization in the choriocapillaris layer in both areas which used to be (a) the large PED and (b) the small satellite PED
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F6
OCTA (RTVue, Optovue, Fremont, California) was performed at this time when there was no PED, and it confirmed the absence of any abnormal choroidal neovascular membrane [Figure 6].
Enhanced-depth imaging optical coherence tomography shows relapses of the (PED). (a) 7 days after receiving 8 mg intravenous dexamethasone, the second relapse of the large PED is shown. (b) After 1 month of observation, subretinal fluid (SRF) developed. (c) After receiving the fifth intravitreal aflibercept injection, PED and SRF completely disappeared. (d) 4 months after the last injection, a shallow PED recurred but was spontaneously resolved. (e) 7 months, (f) 11 months, and (g) 22 months after the last injection, there were no further recurrences of the disease
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F7
SRF on the top [Figure 7]. She was observed for 1 month without improvement and was then treated with intravitreal aflibercept. At the last follow-up visit (22 months after the last intravitreal injection), her vision remained stable, and OCT showed pachychoroid without further recurrences of PED or SRF [Figure 7].