Long-Term Resolution of Perifoveal Exudative Vascular Anomalous Complex after Intravitreal Injections of Anti-Vascular Endothelial Growth Factor

Case Rep Ophthalmol. 2022 Nov 17;13(3):936-942. doi: 10.1159/000526991. eCollection 2022 Sep-Dec.

The condition known as perifoveal exudative vascular anomalous complex (PEVAC) is a rare occurrence with an unclear cause. It was initially identified in 2011 by Querques et al. as a vascular lesion characterized by aneurysmal features, typically found in the perifoveal region of the eye. This condition primarily affects individuals who are otherwise in good health.

Intraretinal cystic spaces are commonly linked to this condition, resulting in visual impairment. Additionally, there may be associations with hemorrhages or hard exudates.

Individuals exhibiting this anomaly do not exhibit unregulated arterial hypertension, diabetes, or other inflammatory or retinal vascular disorders. These conditions have the potential to induce perifoveal retinal vascular irregularities commonly associated with diabetic or hypertensive retinopathy, retinal vein occlusion, inflammatory diseases, ocular ischemic syndrome, or macular telangiectasia. However, the condition can be identified in individuals with effectively managed diabetes and hypertension, provided that there are no indications of concurrent retinopathies. In addition, it is possible for this condition to be accompanied by age-related macular degeneration, epiretinal membrane, lamellar hole, and myopic macular degeneration. However, it should be noted that the presence of these associated findings may be coincidental.

The existing literature lacks comprehensive management guidelines for the limited number of reported cases. Nevertheless, it has been characterized as an entity exhibiting inadequate, delayed, or even absent response to intravitreal injections of anti-VEGF treatment. Therefore, the objective of this study is to document a case involving a patient diagnosed with an exudative polypoidal vasculopathy (ePVAC) who experienced a complete resolution of exudation following a restricted series of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

ABSTRACT

Perifoveal exudative vascular anomalous complex (PEVAC) is a perifoveal aneurysmal vascular lesion found in healthy subjects. A 68-year-old woman was diagnosed with a typical unilateral and unifocal PEVAC lesion after extensive multimodal imaging and was treated with three-monthly intravitreal injections of ranibizumab. An immediate and complete resolution of the intraretinal fluid was observed. Visual acuity returned to 20/20 without any recurrence of the exudative signs along the 5 years of follow-up. Therefore, an initial anti-VEGF treatment with three-monthly intravitreal injections may be considered as a first-line treatment in PEVAC lesions and may result in long-term preservation of visual acuity.

PMID:36466064 | PMC:PMC9710424 | DOI:10.1159/000526991