PMC3680079_01
(A-D) Fundus photography, infrared imaging, spectral domain optical coherence tomography, and fluorescence angiography 3 months before visual symptoms. There is a subfoveal pigment epithelial detachment with minimal subretinal fluid.
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A 71-year-old Caucasian female with a large, stable, subfoveal serous PED in the right eye (RE) and early age-related macular degeneration with confluent drusen in the left eye (LE) had been monitored since March 2008 (Figure 1A-D).
(A-D) The patient complained of sudden metamorphopsia and decreased vision. The pigment epithelial detachment has increased and there is cystoid macular edema. These findings are suggestive of a vascularized pigment epithelial detachment caused by retinal angiomatous proliferation.
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The findings on spectral domain optical coherence tomography and fluorescein angiography were suggestive of a RAP lesion (Figure 2A-D).
(A-D) Fifteen days after the first injection, there is a slight improvement in pigment epithelial detachment height.
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After four biweekly injections of 0.25 mg of ranibizumab, the PED flattened progressively and there were no ocular adverse events, specifically no RPE tears (Figures 3A-D and 4A-D).
(A-D) After four biweekly injections of ranibizumab 0.25 mg, there is a marked improvement in pigment epithelial detachment. Some cystic changes remain, as seen on spectral domain optical coherence tomography, and there are pigmentary changes and lipid deposition in the fundus.
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After four biweekly injections of 0.25 mg of ranibizumab, the PED flattened progressively and there were no ocular adverse events, specifically no RPE tears (Figures 3A-D and 4A-D).
(A-D) Eight months later (November 2012), after four biweekly treatments with ranibizumab 0.25 mg and four additional treatments, as needed, with ranibizumab 0.5 mg, the pigment epithelial detachment is resolved, and minimal subretinal and intraretinal fluid remains.
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At the last visit, on November 2012, metamorphopsia was unnoticeable, BCVA remained at 20/40, and there was a marked anatomic improvement (Figure 5A-D).