PMC4314661_01
Partial pigment ring.. Fundus photograph (
A-D), fluorescein angiogram (FA) mid-phase (
A'-C'), magnified FA (
A"-D") and OCT (
A*-D*) images from a 58 year old female patient presenting with worsening visual acuity to 20/30 and metamorphopsia.
Figures 1A-A*) Images taken prior to treatment show a peri-foveal fluorescein leakage with serous detachment due to CNV. The patient was treated with thermal laser to ablate the CNV lesion.
Figures 1B-B*) After 6 months, CNV recurred in the supero-temporal aspect of the laser scar. The recurrence was treated with combined therapy of 2 PDT and 4 bevacizumab injections applied over a 6 month period.
Figure 1C-C*) After remaining stable for 9 months without treatment, the CNV again recurred in the direction of the thermal laser scar but not in the direction of the partial pigment ring. This recurrence was treated with serial anti-VEGF antibody injections and then remained stable after 42 months with anti-VEGF therapy as shown in
Figure 1D-D*.
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The fundus photograph in Figure 1A, mid-phase FA in Figure 1A', magnified FA in Figure 1A"; and OCT image in Figure 1A* were taken prior to treatment. CNV was initially treated with focal thermal laser and the patient remained stable for 6 months, after which CNV recurred toward the fovea at the supero-temporal edge of the laser scar. Combined therapy with 4 bevacizumab injections (1.25mg/0.05ml) and 2 full dose visudyne PDT treatments were delivered over a 6-month period during which a pigment ring formed to partially surround the CNV lesion ( Figures 1B-B*). Following this period, serous fluid accumulated under the fovea with CNV recurring toward the original thermal laser scar in a direction away from the pigment ring ( Figures 1C-C*). The horizontal OCT images through the CNV lesion ( Figures 1C*-D*) indicate that serous fluid is replaced by RPE layer thickening.