Macular Degeneration

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Case 8-41. Occult Choroidal Neovascularization

Clinical Summary

A 56-year-man with age-related macular degeneration was referred for evaluation of possible choroidal neovascularization in his left eye. He had noted a decline in vision in this eye to 20/160 over a period of four weeks. Examination of the fundus (A) showed subretinal fluid in the macula with exudate along the inferior border Spotty areas of hemorrhage were identified just nasal to the fovea. Fluorescein angiography (B) demonstrated irregular hyper fluorescence in the peripapillary region with late leakage and patchy hypofluorescence corresponding to the region of retina] hemorrhage. No well-defined lesions were noted, Indocyanine green angiography (not shown) revealed several small hyperfluorescent lesions in the superior macula and around the optic nerve head consistent with occult choroidal neovascularization,

Optical Coherence Tomography

A horizontal OCT image (C) was acquired through the superior macula. The tomogram showed a region of enhanced optical scatter signal in the choroid which appeared thicker than adjacent reflection from the pigment epithelium and choriocapillaris, consistent with a neovascular membrane. The retina appeared elevated and thickened in the area of the lesion and nasally with reduced optical reflectivity in the outer retina suggesting subretinal fluid accumulation.

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