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

Torrell-Belzach, Nuria; Mière, Alexandra; Souied, Eric H.; Cohen, Salomon Y.

doi:10.1159/000526991

Cited by 3 publications

(4 citation statements)

References 14 publications

(37 reference statements)

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“…OCT imaging typically features a round lesion with hyperreflective walls in plexiform and nuclear layers with variably reflective contents with surrounding intraretinal fluid/cysts. 6,7 Our case also had characteristics typical of exudative perifoveal vascular anomalous complex lesions described previously. However, the location was peripapillary rather than perifoveal with similar exudative behavior and response to focal laser therapy.…”

Section: Discussionsupporting

confidence: 78%

Exudative vascular anomalous complex-like lesion of the peripapillary area

Temkar,

Natarajan,

Deb

et al. 2023

European Journal of Ophthalmology

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Purpose Perifoveal exudative vascular anomalous complex is an uncommon retinal lesion of idiopathic origin characteristically described as an isolated, aneurysmal lesion of the perifoveal region. We report an unusual presentation of an exudative vascular anomalous complex-like lesion affecting the peripapillary area. Case description A 69-year-old diabetic woman presented with blurred vision in her left eye for two months. Fundus examination of the left eye showed a small, reddish-orange lesion just supratemporal to the optic disc with perifoveal hard exudates and retinal thickening. Fundus fluorescein angiography demonstrated a peripapillary hyperfluorescent lesion with minimal leakage. Ocular coherence tomography showed an oval structure extending throughout the outer and inner plexiform and nuclear layers with a hyper-reflective wall accompanied by subfoveal and intraretinal fluid suggestive of an eVAC-like lesion in the peripapillary area. Intravitreal anti-vascular endothelial growth factor injection was given, and the lesion persisted even three weeks after the injection. Later, focal laser photocoagulation of the aneurysmal lesion was done. At 6 weeks follow-up, a complete resolution of the aneurysmal lesion with a marked decrease in retinal edema and an improvement of the visual acuity was observed. Conclusion Exudative intraretinal aneurysmal lesions can occur in areas other than perifoveal area. OCT is an useful investigation for knowing their characteristics and the response to treatment. These aneurysmal lesions irrespective of their location can be called by the name eVAC-like or more aptly retinal capillary macro aneurysms (RCM).

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Section: Discussionsupporting

confidence: 78%

Exudative vascular anomalous complex-like lesion of the peripapillary area

Temkar,

Natarajan,

Deb

et al. 2023

European Journal of Ophthalmology

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“…It was hypothesized that progressive pericytes’ loss could lead to ePVAC formation, in absence of VEGF upregulation. 1,3,6 This mechanism could explain the partial or absent response of ePVAC to anti-VEGF therapy. However, these previous reports differed in number of injections and type of anti-VEGF molecules used.…”

Section: Discussionmentioning

confidence: 99%

“…3 Treatment options of ePVAC included intravitreal anti-vascular endothelial growth factor (VEGF) injections, although response to anti-VEGF drugs was variable. 1,[3][4][5][6][7] The present study aimed at describing for the first time a typical case of ePVAC in a Brazilian patient with a complete resolution after three monthly intravitreal injections of aflibercept. The possible impact of aflibercept on the pathogenesis of ePVAC was also clarified.…”

Section: Introductionmentioning

confidence: 99%

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A Brazilian case of exudative perifoveal vascular anomalous complex responsive to aflibercept intravitreal injections

Cunha de Souza,

Tombolini,

Sacconi

et al. 2023

European Journal of Ophthalmology

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Purpose To report a case of exudative perifoveal exudative vascular anomalous complex (ePVAC) in a Brazilian healthy patient that underwent a complete resolution after aflibercept intravitreal injections. Case description A 41-year-old healthy Brazilian man complained of acute central vision loss in his right eye (RE). Fundus examination showed a perifoveal hemorrhagic aneurysmal lesion, accompanied by several hard exudates in RE. On fluorescein angiography, these abnormalities showed a progressive hyperfluorescence with surrounding leakage. Optical coherence tomography (OCT) revealed a deep, perifoveal hyporeflective cystic space with a hyperreflective wall and hyperreflective material inside of fibrin-like aspect. Around this aneurism, intraretinal hyporeflective spaces suggestive of exudation were detected. Nor pathological flow signal, or telangiectatic dilations were evidenced on OCT-angiography. Therefore, a diagnosis of exudative ePVAC in RE was hypothesized. After an initial observation, the patient underwent three monthly aflibercept intravitreal injections (0.05 ml/2 mg), with a significative anatomical and functional improvement after two weeks from first dose. On last follow-up at five months from baseline, patient experienced no evidence of new exudation and a stable visual acuity. Discussion Placental growth factor (PlGF) may impact on pericytes’ dropout, and thus on ePVAC development. In contrast to the other anti-VEGF drugs, aflibercept is the only molecule contrasting PlGF. Therefore, aflibercept would act on ePVAC not as an anti-VEGF drug, but rather as an anti-PlGF one. Conclusion This report encouraged the use of aflibercept as a therapeutic option for ePVAC. Further studies are required to confirm our result and the impact of PlGF on ePVAC pathogenesis.

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