Eighty year old female patient presented with the decreased visual acuity in both eyes. The BCVAs were 20/200 for both eyes and the IOPs were within normal limits. Slit-lamp examination showed nuclear sclerosis ib both eyes. Dilated fundus examination revealed drusen, macular atrophy, focal RPE hyperplasia and intraretinal hemorrhage.
Fundus fluorescein angiography of the right and left eyes showed late leakage of undetermined source with poorly determined borders in addition to some window-defect hyperfluorescence.
Spectral-domain OCT images of the right and left eyes exhibited multilayered fibrovascular PED with hyperreflective material in addition to hyporeflective intraretinal fluid and hyperreflective exudate and hemorrhage. Moreover, a hyporeflective space between the neovascular hyperreflective tissue and Bruch’s membrane indicating prechoroidal cleft was observed in both eyes.
In light of these multimodal imaging findings, the diagnosis of bilateral type 1 macular neovascularization with accompanied by prechoroidal cleft was made and the patient was treated with bilateral intravitreal aflibercept injection. One-month after the first dose aflibercept injection, the OCT revealed the complete intraretinal fluid resorption and complete regression of prechoroidal cleft.
Credit: Kemal Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
Instagram accounts: @retina.academy and @dr.kemaltekin