Selective Focal Laser Therapy as the Primary Treatment for Exudative Perifoveal Vascular Anomalous Complex (ePVAC): Case Series and Literature Review

Abstract

Perifoveal anomalous exudative vascular complex (PEVAC) was first described in 2011. Since then, individual clinical cases and a couple of case series have been published, and their characteristics have been studied in multi-modal images. To date, there is no consensus on its treatment. Initially, it was thought that PEVACs could be left to spontaneous evolution because they presented a slow progression. But it has been shown that the growth of the lesion covers a spectrum from non-exudative lesions to PEVAC with vision impairment over time. We present an updated bibliographic review of this pathology. We explain the changes in the diagnostic criteria that have been undergone. And we focus the discussion on selective treatment with focal laser, which has shown an excellent anatomical response and visual improvement or stabilization in the cases described and in our series of three patients systematically treated with focal laser. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:43–49.]

Intraretinal Macroaneurysms and Multimodal Imaging: A Retrospective Analysis

“…The response to anti-VEGF treatment was poor. 11 , 12 , 16 , 30 , 31 It appeared as a round hyperreflective lesion with a reflective wall, surrounding a dark lumen containing reflective material in a variable nature. Intraretinal cystic spaces generally accompanied these lesions on OCT. A fluorescein angiogram showed the hyperfluorescent lesion, characterized as an isolated aneurysmal dilation with a variable filling of the aneurysm associated with some leakage on the late frames.…”