Management of Perifoveal Exudative Vascular Anomalous Complex

Maria Cristina Savastano; Claudia Fossataro; Gianni Gravina; Francesca Coccimiglio; Clara Rizzo; Stanislao Rizzo

doi:10.1097/ICB.0000000000001649

Management of Perifoveal Exudative Vascular Anomalous Complex

Retin Cases Brief Rep. 2024 Aug 5. doi: 10.1097/ICB.0000000000001649. Online ahead of print.

Authors

Maria Cristina Savastano^{1

2}, Claudia Fossataro^{1

2}, Gianni Gravina^{1

2}, Francesca Coccimiglio^{1

2}, Clara Rizzo³, Stanislao Rizzo^{1

2

4}

Affiliations

¹ Ophthalmology Unit, "Fondazione Policlinico Univesitario Agostino Gemelli, IRCCS", Rome - Italy.
² Catholic University "Sacro Cuore", Largo A. Gemelli 8, 00168- Rome, Italy.
³ Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37219, Verona, Italy.
⁴ Neuroscience Institute of CNR, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.

PMID: 39106415
DOI: 10.1097/ICB.0000000000001649

Abstract

Purpose: To report a case of a patient with perifoveal exudative vascular anomalous complex (PEVAC) and to analyze morphological and vascular changes by OCT and OCTA before and after treatment.

Materials and methods: In this case we reported a case which received multiple treatment for unresponsive effect to Repeated Aflibercept intravitreal injections, subthreshold micropulse laser therapy (SMPL) duty cycle 5%. At last the focal fully dose yellow laser was performed.

Results: A 57-year-old male patient presented with best corrected visual acuity (BCVA) of 20/50 in his right eye (RE) The fundoscopic evaluation, structural optical coherence tomography (OCT) and OCT angiography (OCTA) deposed for a diagnosis of PEVAC. The patient underwent three Aflibercept intravitreal injections in the RE. Since no changes were detected, we opted for multiple sessions of yellow subthreshold micropulse laser therapy (SMPL) duty cycle 5%, however no signs of regression were registered. Only after a fully dose yellow laser, signs of edema regression were observed. Stuctural OCT B-scan showed complete restitutio of retinal profile, in absence of any intraretinal or subretinal fluid and PEVAC lesion, while the OCTA showed a slight flow deficit at the previous lesion site.

Conclusions: and Importance: The PEVAC treatment is still unknown. In our experience, we reported a case of multiple treatments for unresponsive effect to: Aflibercept intravitreal injections, subthreshold micropulse laser therapy (SMPL) duty cycle 5%. At list the focal fully dose yellow laser was the only effective in our patient. We proposed our management to share the heterogeneous response at PEVAC entity.