Optical Coherence Tomography Angiography Evolution of Choroidal Neovascular Membrane in Choroidal Rupture Managed by Intravitreal Bevacizumab

Abstract

Purpose To describe a case of a 25-year-old man with choroidal neovascularization (CNV) secondary to traumatic choroidal rupture treated with intravitreal bevacizumab and to evaluate the vascular structure of the area near the traumatic choroidal rupture. Methods The patient underwent complete ophthalmologic evaluation, including best-corrected visual acuity (BCVA), intraocular pressure, anterior segment and funds examination, and optical coherence tomography angiography (OCTA) at baseline and on each follow-up visit. Fluorescein angiography (FA) was performed at baseline. Intravitreal bevacizumab was administered at the time of choroidal neovascular membrane diagnosis. Results At baseline, ophthalmoscopic examination of the left eye revealed four subretinal macular hemorrhages and two choroidal ruptures located temporally to the fovea. On OCT angiograms, the choroidal rupture appeared as a hypointense break in choriocapillaris plexus. At 4-week follow-up, the OCTA disclosed a well circumscribed lesion characterized by numerous and fine anastomotic vessels. Patient received intravitreal injection of bevacizumab. At 6-week post injection, OCTA documented regression of the neovascular complex. Conclusion Choroidal neovascularization is a common complication associated with traumatic choroidal rupture and OCTA may represent a complementary diagnostic technique to evaluate the vascular structure of the area near the traumatic choroidal rupture.

Optical coherence tomography angiography-guided diagnosis of a traumatic choroidal rupture-associated choroidal neovasular membrane and its management with intravitreal ranibizumab

“…demonstrated OCTA-guided evolution of posttraumatic CR-associated CNVM managed with single intravitreal bevacizumab in two separate reports. [ 14 15 ] Preziosa et al . described a defined tangled network of CNVM within a regular line of severe choriocapillary rarefaction corresponding to the area of CR by OCTA.…”

“…Although there are a few case series describing the management of posttraumatic CR associated CNVM with anti-VEGF, the literature has very few isolated case reports demonstrating the use of OCTA in depicting the evolution of CR associated CNVM. [ 13 14 15 16 17 ] In the index report, we presented OCTA-guided the diagnosis of secondary CNVM following CR, where conventional FFA could not be performed and also showed its successful management with single injection of intravitreal ranibizumab.…”

Choroidal Neovascularization Associated with Rare Entities

“…OCT reveals SRF, IRF, and hyper-reflective subretinal material. Recently, OCT-angiography has been found useful in demonstrating neovascular tuft within choroidal rupture [118,119]. Care should be taken not to mistake projection artifacts from normal retinal or choroidal vessels with neovascularization.…”

Spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture depicted on OCT angiography

“…6 Isolated case reports and case series have described the detection and evolution of choroidal neovascularization secondary to traumatic choroidal rupture treated with anti-VEGF therapy using OCT angiography. [3][4][5]7,8 Using this non-invasive technology, the present case describes early detection of choroidal neovascular Yellowish appearing de-hemoglobinized hemorrhage is visible at the edges of fresh hemorrhage. (B) Fundus autofluorescence of the left eye shows a central area of hypoautofluorescence correlating with fovea involving vertical choroidal rupture surrounded by a ring of hyperautofluorescence correlating with the de-hemoglobinized hemorrhage.…”

“…1,2 Typically, choroidal neovascularization secondary to traumatic choroidal rupture is treated with anti-vascular endothelial growth factor (anti-VEGF) therapy in the form of Bevacizumab. [3][4][5] Usually, 1-3 injections of Bevacizumab may be required to cause inactivation and regression of choroidal neovascularization. 5 Since the introduction of optical coherence tomography (OCT) angiography, a non-invasive evaluation of retinal and choroidal microvasculature in different posterior segment conditions, monitoring of choroidal neovascular complexes and assessment of the ischemic changes in the retina has become possible.…”