Macular hole and serous pigment epithelial detachment in bil
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A 66-year-old woman was referred with suspicion of AMD. She reported bilateral metamorphopsia; the best-corrected visual acuity (BCVA) was 20/17 in both eyes. In the right eye, submacular vitelliform lesions were observed with hyperautofluorescence; in the left eye, a flat sPED was observed. The pachychoroid seen in both eyes exceeded 300 m. Fluorescein angiography (FA) showed bilateral pattern dystrophy-like hypofluorescence and a local leakage point of fluorescent dye in the right eye, which led to a diagnosis of AVLs complicated by central serous chorioretinopathy in the right eye and atypical pachychoroid pigment epitheliopathy in the left eye.

The sPED became enlarged and bullous in the left eye and was accompanied by AVLs with hyperautofluorescence. Therefore, intravitreal aflibercept (IVA) and a sub-Tenon's injection of triamcinolone acetonide (STTA) were administered followed by photodynamic therapy (PDT) the following day. One month after IVA/STTA/PDT, the sPED flattened with no recurrence, and good vision was preserved. The BCVA at the final visit was 20/13.

Because the patient expected the persistent AVLs in the right eye to be treated, intravitreal ranibizumab and tissue plasminogen activator were administered in October after the patient provided informed consent. Immediately after IVR/tPA was administered, the subretinal hyperreflective material was seen on an optical coherence tomography (OCT) image started to resolve. The ACLs shrank, and the BCVA was maintained at 20/20. Furthermore, macular atrophy, the end-stage of the AVLs, developed and progressed after vitrectomy, and the BCVA decreased to 20/100 at the final visit.

Source: https://www.sciencedirect.com/science/article/pii/S2451993620300244
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