PMC5042184_01
FA of the patient's right eye taken over a 2-year period.. Notes: (A and B) Initial visit (early phase of FA of the right eye reveals a small irregular hyperfluorescence area inferonasal to the fovea with late-phase leakage that corresponds to the juxtamacular CNV lesion; arrows). (C and D) One week after cessation of steroid therapy (a fulminant recurrence and development of CNV membrane with involvement of the fovea; arrows). (E and F) Three months after PDT (progressive enlargement of CNV membrane). (G) Recurrent activity of CNV membrane 8 months after the second intravitreal ranibizumab injection (circle). (H) Two months after periocular triamcinolone injection combined with intravitreal ranibizumab injection (almost complete regression of active CNV membrane).. Abbreviations: CNV, choroidal neovascular membrane; FA, fluorescein angiography; PDT, photodynamic therapy.
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Fluorescein angiography (Figure 1) revealed a tiny CNV membrane developing from the juxtafoveal focus (Figure 1A [early phase] and B [late phase]). One week after completion of systemic steroid therapy, BCVA was reduced to 0.6 as a result of sudden relapse and significant expansion of CNV membrane toward the fovea (Figure 1C [early phase] and D [late phase]). No changes were observed in BCVA 3 months after PDT; the value remained at the level of 0.6 with further slight expansion of CNV membrane being observed angiographically (Figure 1E [early phase] and F [late phase]). Clinical examination, fluorescein angiography, and OCT revealed a subfoveal scar and atrophic lesions as well as recurrent CNV membrane growth from the original locus, this time toward the optic disk (Figures 1G and 2D). After 2 months, BCVA in the right eye remained at the level of 0.2, with almost complete regression of the recurrent lesion activity (Figure 1H).
OCT examination results.. Notes: (A) OCT image of the right macula 2 months after the first intravitreal ranibizumab injection. Complete resolution of intraretinal fluid. (B and C) OCT images of the right macula before (B) and 1 month after (C) the second intravitreal ranibizumab injection, which resulted in CNV membrane inactivation. (D) OCT images of the right macula before periocular triamcinolone injection combined with intravitreal ranibizumab injection. (E) OCT image of the right macula at 5 years. Chorioretinal atrophic changes and scarring (D).. Abbreviations: CNV, choroidal neovascular membrane; OCT, optical coherence tomography.
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Stabilization of visual acuity of the right eye at the level of 0.4-0.5 was observed over the following 4 months, accompanied by regression of the CNV membrane and elimination of fluid seen in optical coherence tomography (OCT) scans (Figure 2A). Six months after the first injection, a repeated increase in CNV membrane activity confirmed by OCT led to the need of the second ranibizumab injection, again resulting in membrane regression and fluid elimination (Figure 2B [before injection] and C [after injection]). Clinical examination, fluorescein angiography, and OCT revealed a subfoveal scar and atrophic lesions as well as recurrent CNV membrane growth from the original locus, this time toward the optic disk (Figures 1G and 2D). Since that time, the condition has remained stable over a 5-year follow-up period (Figure 2E).