This was an 85-year-old pseudophakic female with a history of systemic arterial hypertension and hypercholesterolemia, who presented with a gradual visual decline in her left eye. She had no history of diabetes mellitus; fasting glucose and HbA1c levels were within normal limits. There was no previous ocular history or treatment.
BCVA was 20/25 in the right eye and 20/50 in the left eye. Intraocular pressure was within normal limits bilaterally. Anterior segment examination was unremarkable, and both eyes were pseudophakic. Fundus examination revealed perifoveal vascular dilations in both eyes. The left eye showed more prominent perifoveal vascular anomalies associated with lipid exudates.
Near-infrared reflectance imaging
Autofluorescence images
Spectral-domain optical coherence tomography (SD-OCT) of the right eye showed focal perifoveal vascular dilations associated with an isolated intraretinal cyst. In the left eye, OCT revealed dilated perifoveal vessels, intraretinal fluid, and hard exudates.
Fluorescein angiography (FA) demonstrated punctate areas of hyperfluorescence corresponding to the vascular microdilations with late staining, more prominent in the left eye. Macular pooling of fluorescein was evident bilaterally, consistent with macular edema. In the left eye, hypofluorescent masking due to hard exudates was also noted.
Based on multimodal imaging findings, a diagnosis of Perifoveal Exudative Vascular Anomalous Complex (PEVAC) was made.
Perifoveal Exudative Vascular Anomalous Complex (PEVAC) is a rare, idiopathic, retinal vascular anomaly characterized by isolated perifoveal vascular dilation associated with intraretinal cysts or macular edema. It typically presents in older adults without diabetic retinopathy or other retinal vascular disorders. Multimodal imaging, especially OCT and FA, is crucial for diagnosis. Although the pathogenesis remains unclear, the lesion tends to progress slowly. Treatment is individualized: anti-VEGF therapy or intravitreal steroid may be used in exudative cases, though response can be variable.