Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Retina
Case 84
Patient presentation: A 71-year-old East-Asian female was referred to a tertiary retina service for a 2-week history of reduced vision and a paracentral scotoma in her right eye. She had a past ocular history of cataract surgery in both eyes. She had a past medical history of hypertension and dyslipidemia. She denied eye pain, GCA symptoms, flashes, floaters or a history of trauma. Visual acuity on presentation is 20/50 right eye and 20/25 left eye. IOP is within normal limits. There is no RAPD. OCT macula imaging was taken and is shown below:
Question 1: Describe the main findings on OCT imaging.
Optical coherence tomography angiography (OCT-A) was performed and is shown below:
Question 2: Describe the OCT-A findings.
Question 3: What is the most likely diagnosis?
Question 4: What is the best mode of differentiating PCV from other forms of neovascularization?
Question 5: What is the management of PCV?
References:
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Honda S, Matsumiya W, Negi A. Polypoidal choroidal vasculopathy: clinical features and genetic predisposition. Ophthalmologica. 2014;231(2):59-74. doi:10.1159/000355488
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Imamura Y, Engelbert M, Iida T, Freund KB, Yannuzzi LA. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol. 2010;55(6):501-515. doi:10.1016/j.survophthal.2010.03.004
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Spaide RF, Yannuzzi LA, Slakter JS, Sorenson J, Orlach DA. Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina. 1995;15(2):100-110. doi:10.1097/00006982-199515020-00003
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Koh AH; Expert PCV Panel, Chen LJ, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina. 2013;33(4):686-716. doi:10.1097/IAE.0b013e3182852446
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Newman DK. Photodynamic therapy: current role in the treatment of chorioretinal conditions. Eye (Lond). 2016;30(2):202-210. doi:10.1038/eye.2015.251
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Koh A, Lee WK, Chen LJ, et al. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina. 2012;32(8):1453-1464. doi:10.1097/IAE.0b013e31824f91e8
Learning Objectives:
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To identify OCT and OCT-A features of polypoidal choroidal vasculopathy.
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To understand the management of polypoidal choroidal vasculopathy.