PMC3935506_01
Findings from case 1, a 79-year-old Japanese man with a large PED in the left eye with PCV.. Notes: (A) Fundus photograph of the left eye at the initial examination showing a large serous retinal PED. His BCVA was 2/20 OS. (B) FA image of the left eye at the initial visit showing late leakage at the base of the PED suggestive of occult CNV and pooling of dye within the serous PED. (C) IA images at the initial visit showing hyperfluorescent spots in the choroidal circulation at the base of the PED suggesting the presence of polyps and hypofluorescence in the serous PED lesion. (D) Fundus photograph taken after three monthly aflibercept injections. The large serous PED is not present. (E) SD-OCT images of the left eye at the initial examination showing a large serous PED with SRF. The PED appears to be optically empty. Reflective material beneath the RPE layer (white arrow) suggestive of an occult CNV was detected that corresponded to the lesion of late leakage by FA. (F) SD-OCT image 6 months after three monthly injections of ranibizumab. Three monthly injections of ranibizumab slightly flattened the PED and reduced the SRF. However 6 months later, recurrent SRF and PED were observed. Hyper-reflective materials (white arrowhead) beneath the outer surface of the RPE can be seen. (G) SD-OCT image showing near resolution of the PED with complete resolution of the SRF after three additional monthly injections of ranibizumab (total of six injections). Sub-RPE materials (white arrowhead) can be seen even though the PED is collapsed. (H) One month after the last injection of ranibizumab, a recurrent large PED can be seen. (I) Flattened PED 2 weeks after a single aflibercept injection. Sub-RPE materials (white arrowhead) can be seen. (J) A complete resolution of the PED after the second injection of aflibercept, although reflective materials (white arrowhead), suggesting fibrovascular tissue, can be seen within the PED beneath the RPE layer. (K) SD-OCT image of (D). After three monthly injections of aflibercept, complete resolution of PED had a fibrovascular PED. BCVA remained 2/20 OS.. Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; FA, fluorescein angiography; IA, indocyanine green; OS, oculus sinister; PCV, polypoidal choroidal vasculopathy; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SD-OCT, spectral domain optical coherence tomographic; SRF, subretinal fluid.
opth-8-343Fig1.jpg
PMC3935506_01_opth-8-343Fig1.jpg
f1-opth-8-343
The BCVA remained at 2/20 OS (Figure 1).
PMC3935506_02
PMC3935506_03
Images from case 3, an 80-year-old Japanese man with a large PED associated with a PCV in the left eye.. Notes: (A-C and G). Images at the initial visit. (A) Fundus photograph of the left eye at the initial visit shows a large serous PED. His BCVA was 10/20 OS. (B) FA images of the left eye at the initial visit showing late leakage at the base of the PED suggestive of an occult CNV and pooling of dye within the serous PED. (C) IA image showing hyperfluorescent spots from the choroidal circulation at the base of the PED suggestive of polyps and hypofluorescence in the PED lesion. (D) Fundus photograph after a single injection of aflibercept. The large serous PED is still present. (E) After two monthly injections of aflibercept, an exudative lesion with small hemorrhages can be seen instead of the serous PED. Yellowish precipitates are faintly seen in the subretinal space. (F) One day after the third monthly injection of aflibercept. The patient reported a central dark spot, a scotoma, in his left eye. Fundus photograph shows the presence of a subretinal hemorrhage and a recurrent PED. The PED was hemorrhagic. The BCVA was reduced to 2/20. (G-M) SD-OCT images of the left eye. (G) SD-OCT shows a large serous PED with SRF at the initial examination. The PED is optically empty but hyper-reflective materials (white arrowheads) can be seen beneath the outer surface of the RPE. Hyper-reflective materials located at the base of the temporal side of the PED, corresponding to the late leakage by FA, suggesting an occult CNV lesion, can be seen beneath the RPE layer. (H) SD-OCT image showing that three monthly injections of ranibizumab slightly flattened the PED and reduced the SRF. (I) Three months after the last injection of ranibizumab, a recurrence of the SRF and PED are observed. Hyper-reflective materials (white arrowhead) can be seen along the outer surface of the RPE. (J) SD-OCT shows that the PED with SRF enlarged despite three additional monthly ranibizumab injections (total of six injections). Hyper-reflective materials (white arrowhead) from the back surface of the RPE layer were increased. (K) SD-OCT image of (D). A single aflibercept injection did not resolve the PED and SRF but worsened. (L) SD-OCT image of (E). After two monthly injections of aflibercept, a near resolution of PED with complete resolution of SRF can be seen. However, hyper-reflective materials, suggesting the existence of fibrovascular PED, are present beneath the RPE layer. (M) SD-OCT image of (F). After three monthly injections of aflibercept, a recurrent large PED with SRF can be seen. Hyper-reflective materials reflecting hemorrhages in the subretinal space and PED space were detected. BCVA was reduced to 2/20.. Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; FA, fluorescein angiography; IA, indocyanine green; OS, oculus sinister; PCV, polypoidal choroidal vasculopathy; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SD-OCT, spectral domain optical coherence tomographic; SRF, subretinal fluid.
opth-8-343Fig2.jpg
PMC3935506_03_opth-8-343Fig2.jpg
f2-opth-8-343
BCVA was reduced to 2/20 (Figure 2).