Case Report: A Case of Perifoveal Exudative Vascular Anomalous Complex With a Good Prognosis

Fu, Minyue; Pan, Hongge; Zhang, Gang; Huang, Ludonghan; Xu, Huan; Huang, Ju; Wu, Meihui; Chen, Yanli

doi:10.3389/fmed.2021.757313

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…(For figure see next page.) location of the lesion allowed to perform the photocoagulation [7,12], and recently one case reported by Tombolini and associates improvement after 1 month of a topical non-steroidal anti-inflammatory drug [13].…”

Section: Discussionmentioning

confidence: 99%

“…Different publications are consistent with this statement, but the number of total injections from patients who received treatment with anti-VEGF intravitreal injections ranged from just one to a total of four [ 1 , 3 , 4 , 6 , 9 , 10 , 11 ], except for 1 patient treated by Mrejen et al [ 7 ], which showed sustainable resolution of the exudation after 13 anti-VEGF injections, and a patient with PEVAC associated with a lamellar hole who partially responded to 3 injections of ranibizumab with a significant decrease of the edema [ 8 ]. In addition, other publications have demonstrated a good response to laser therapy, when the location of the lesion allowed to perform the photocoagulation [ 7 , 12 ], and recently one case reported by Tombolini and associates improvement after 1 month of a topical non-steroidal anti-inflammatory drug [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

Torrell-Belzach

Mière

Souied

et al. 2022

Case Rep Ophthalmol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Torrell-Belzach

Mière

Souied

et al. 2022

Case Rep Ophthalmol

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“…But, PEVAC is seen as a well defined hyperfluorescent lesion with minimal leak on FFA. 8,9 In our case, the lesion was hypofluorescent with no leak till 11 minutes on FFA. But, within 1 month of laser, the edema resolved and OCT confirmed the occlusion of lesion indicating that the edema was due to the leak from the lesion.…”

Section: Np88mentioning

confidence: 46%

Laser photocoagulation of a hypofluorescent perifoveal exudative vascular anomalous complex/capillary macroaneurysm

Sagar¹,

Sahare²,

Shanmugam

et al. 2022

European Journal of Ophthalmology

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Purpose To report successful treatment of a hypofluorescent perifoveal exudative vascular anomalous complex (PEVAC)/capillary macroaneurysm. Case description A 63 year old healthy gentleman had a perifoveal isolated aneurysmal lesion with white rim. Optical coherence tomography (OCT) showed cystoid macular edema (CME) with neurosensory detachment. The aneurysmal lesion was seen in the inner retina as a hyperreflective intraretinal structure with a heterogenous lumen suggestive of PEVAC/capillary macroaneurysm. OCT angiography showed a capillary loop and a slightly hyperreflective lesion at the tip of the loop in the superficial capillary plexus slab. Minimal reduction in edema was noted following one dose of intravitreal triamcinolone (2 mg). Fundus fluorescein angiography performed at 6 weeks demonstrated the capillary loop, but the aneurysmal lesion remained hypofluorescent with no definite leak in the late phase. Few perifoveal microaneurysms were seen in both the eyes. Six weeks later, focal laser photocoagulation of the aneurysmal lesion was performed, which resulted in complete resolution of macular edema at 1 month. There was no recurrence of macular edema till his recent follow up, which is 4 month post laser. Discussion PEVAC is typically described as unifocal lesion and is not associated with other retinal vascular abnormalities. But in this case, in addition to the lesion, perifoveal microaneurysms were seen in both the eyes. Despite the absence of leak on fundus fluorescein angiography, targeted focal laser photocoagulation resulted in complete resolution of macular edema at 1 month. Conclusion Laser photocoagulation would be helpful even in hypofluorescent PEVAC/capillary macroaneurysms.

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“…Fu and colleagues believed that a photoinduced biological effect on neuroretina tissues and cells may play a role in PVAC treatment with MPL. 11 We think that the use of intravitreal triamcinolone may be an effective and affordable alternative for the treatment of PVAC associated with macular edema. Our results imply an inflammatory mechanism associated with PVAC accompanied by macular edema.…”

Section: Discussionmentioning

confidence: 99%

Perifoveal exudative vascular anomalous complex and resembling lesions treated with intravitreal triamcinolone

Damasceno

Horowitz²,

Yannuzzi

et al. 2023

European Journal of Ophthalmology

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Purpose To report the use of intravitreal triamcinolone to treat macular edema associated with isolated perifoveal exudative vascular anomalous complex (PVAC) and resembling lesion (PVAC-RL). Methods In this case series, three diabetic patients (3 eyes) with PVAC-RLs and one healthy patient (1 eye) with PVAC lesion associated with cystic spaces underwent three intravitreal injections of aflibercept before switching to one intravitreal triamcinolone injection in each patient. Results Macular edema improved from 297.5 ± 8.10 μm, at baseline, to 269.2 ± 8.89 μm, after triamcinolone; whereas visual acuity improved from 20/38 to 20/26 (ETDRS). Conclusion PVAC and PVAC-RL are rare and often misdiagnosed lesions that may be associated with decreased vision. Our outcomes suggest that intravitreal injection of triamcinolone may be an effective and affordable treatment for PVAC and PVAC-RL with intraretinal fluid.

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Case Report: A Case of Perifoveal Exudative Vascular Anomalous Complex With a Good Prognosis

Cited by 6 publications

References 20 publications

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

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

Laser photocoagulation of a hypofluorescent perifoveal exudative vascular anomalous complex/capillary macroaneurysm

Perifoveal exudative vascular anomalous complex and resembling lesions treated with intravitreal triamcinolone

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