Multimodal imaging in perifoveal exudative vascular anomalous complex with co‐existent diabetic retinopathy

Venkatesh, Ramesh; Yadav, Naresh Kumar; Bavaharan, Bharathi; Prabhu, Vishma; Sinha, Shivani

doi:10.1111/cxo.12868

Cited by 15 publications

(5 citation statements)

References 5 publications

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“…However, in 2019, Venkatsh et al and Zhang et al identified PVAC in a diabetic patient who was unresponsive to anti-VEGF injections. 9,10 Moreover, in 2021, Smid and associates referred to a lesion as PVAC-resembling when it occurred in patients affected by other vascular or inflammatory abnormalities. 7 Despite the similar clinical, morphological, and vascular features between PVAC and PVAC-resembling lesions, PVAC lesion is considered a microangiopathy of unknown origin as it occurs in healthy patients.…”

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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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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“…The possible reasons are as follows ( 1 ): first, under an absence of capillary ischemia or inflammation, progressive retinal endothelial cell degeneration may trigger the vasogenic cellular mechanism for PEVAC; and second, the disease may be related to T3NV /RAP. In 2019, Venkatsh et al ( 4 ) and Zhengwei Zhang et al ( 6 ) reported the case of a patient with diabetes with PEVAC in whom anti-VEGF injection treatment was ineffective, which further indicated that PEVAC may not only occur in healthy eyes.…”

Section: Discussionmentioning

confidence: 99%

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

Pan

Zhang³

et al. 2021

Front. Med.

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Significance: Perifoveal exudative vascular anomalous complex (PEVAC) is a unique clinical lesion. It manifests as isolated lesions and is easily misdiagnosed. Thus far, few PEVAC case reports have been published. PEVAC is typically inconsistent with other reported macular lesions.Purpose: To report our 24-month follow-up experience on the treatment of PEVAC with a micropulse laser (MPL).Case Report: A 56-year-old Chinese woman with no history of other diseases complained of decreased vision in her left eye that had persisted for more than 1 year. Comprehensive ophthalmic examinations were performed, including a vision test, slit lamp fundus exam, optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA). Intravitreal injection of ranibizumab was ineffective, and bleeding, exudation and visual acuity were not improved. After two rounds of micropulse laser (MPL) treatment, the patient was followed up, and the prognosis was good.Conclusion: PEVAC is very rare, and early diagnosis is important, as the lesions readily cause irreversible damage. Our results indicate that an MPL can be used as an alternative treatment for PEVAC patients.

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“…2,3 Later, few authors described the occurrence of PEVAC in patients with diabetes mellitus. 4 Till date, all the cases of PEVAC described in literature are unilateral and the maximum number of lesions found in one eye is two. PEVAC is described to be associated with minimal leak on fundus fluorescein angiography (FFA).…”

Section: Introductionmentioning

confidence: 99%

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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Multimodal imaging in perifoveal exudative vascular anomalous complex with co‐existent diabetic retinopathy

Cited by 15 publications

References 5 publications

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

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

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

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

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