Managing peripheral haemorrhagic polypoidal choroidal vasculopathy in a one-eyed patient

Author: Chekitaan Singh (India)

Co-authors: Reena Gupta, Ishwar Singh, Prajjwal Kumar

Purpose

To describe management strategies for a case of peripheral IPCV in a patient who lost one eye to a similar disease in the past

Setting/Venue

Ishwar Eye Centre, a tertiary referral eye care centre in Northern India

Methods

Best corrected visual acuity(BCVA), slit lamp and fundus examination by indirect ophthalmoscopy, fundus photography,fundus fluorescein angiography(FFA) and optical coherence tomography(OCT) were performed. Anti -vegf injection in the form of Eylea(aflibercept) was administered intra vitreally in the affected eye. Focal laser treatment of the lesion was performed with 532-frequency doubled ND-YAG laser aiming for moderate white confluent burns. follow up fundus photographs and OCT were performed

Results

A 60 year old female asian non diabetic ,non hypertensive patient came for regular retina check up. Her right eye had BCVA OF 6/9 and left eye had counting fingers vision. There was past history of massive sub-RPE and sub-retinal haemorrhage which was managed surgically with subsequent profound loss of vision. slit lamp examination was un remarkable. Fundus examination revealed a large(2-3 disc diameters) hemorrhagic pigment epithelial detachment (H-PED) temporal and inferior to the arcade. FFA showed blocked fluorescence and OCT showed a very large H-PED. the left eye showed extensive retinal pigment and retinal atrophy throughout the posterior pole. The patient was advised Intra-vitreal injection Aflibercept (Eylea) explaining the risks and benefits, which the patient subsequently underwent without complications. At one month follow-up the H-PED did not show any change in size or morphology in the right eye. At this juncture keeping in mind the lack of response to aflibercept and the severe complications of massive haemorrhage in the left eye, focal laser to the entire lesion was done with informed consent. The H-PED showed some reduction in size at week 2 and complete resolution at 5-6 weeks post laser treatment. the patient is on follow -up

Conlusions

Focal 532-FD-ND-YAG LASER is a very effective way of treating a mid -peripheral large haemorrhage pigment epithelial detachment when even potent Anti-VEGF injections fail to produce desired effects.

Financial Disclosure

NO FINANCIAL RELATIONS