Macular Degenera t on

Case 8-32. Recurrent Choroidal Neovascularization

Clinical Summary

A 65-year-old man was referred for recurrent choroi-

fr dai neovascularization in his left macula. He had presented four months earlier for evaluation of a decrease in his vision in his left eye to 20/40, Fundus examination at that time revealed subretinal hemorrhage nasal to the macula* Fluorescein angiography showed paramacular subpigment epithelial neovascularization, and diode laser photocoagulation was performed.

Follow-up slit-lamp examination (A) two weeks later demonstrated persistence of the neovascular membrane in the macula. A lesion in the central macula which was described as either a hemorrhagic pigment epithelial detachment or a subretinal thrombus was observed, with surrounding subretinal fluid, exudate, and trace hemorrhage. The patients visual acuity had deteriorated to 20/ 400. Fluorescein angiography (B) displayed a hypofluorescent lesion in the central macula with mild hyperfluorescence along the inferonasal rim. The entire rim of the lesion became hy per fluorescent as the angiogram progressed, and well-defined pooling of dye was observed in the entire region in the late phases.

Optical Coherence Tomography

A vertical OCT tomogram (C) showed what appeared to be a tuft of tissue extending from the choroid into the neurosensory retina, consistent with a neovascular mem-

brane. The reflection from the pigment epithelium was totally absent in this region. The surrounding neurosensory retina was detached, w ith the accumulation of a mini-

j mally backsca tiering fluid in the subretinal space.

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