J Korean Ophthalmol Soc.  2018 Jul;59(7):680-686. 10.3341/jkos.2018.59.7.680.

A Case of Polypoidal Choroidal Vasculopathy and Serous Retinal Detachment in a Bilateral Dome-shaped Macula

• Yoon JH
• Park DH
• Shin JP

• KMID: 2416272
• DOI: http://doi.org/10.3341/jkos.2018.59.7.680

Abstract

PURPOSE
To report a case of polypoidal choroidal vasculopathy in the right eye which improved after intravitreal injection of anti-vascular endothelial growth factor, and serous retinal detachment (SRD) in the left eye which improved spontaneously in a patient with a bilateral dome-shaped macula (DSM) with a tilted optic disc and inferonasal posterior staphyloma.
CASE SUMMARY
A 50-year-old female visited our clinic with visual disturbance of the right eye for 5 days. A tilted optic disc with inferonasal posterior staphyloma and DSM were observed in both eyes by fundus examination and spectral domain optical coherence tomography (SD-OCT), and there was no specific finding in the left eye, but pigment epithelial detachment (PED) with subretinal hemorrhage was observed in the right eye. Polyps and branching vascular networks were found using indocyanine green angiography. We performed intravitreal C3F8 gas and aflibercept injection. After 3 months, SD-OCT of the right eye showed no subretinal hemorrhage and diminished PED. SD-OCT of the left eye showed SRD but the SRD disappeared after 1 month. SD-OCT of the left eye showed no recurrence of the SRD.
CONCLUSIONS
In a patient with a tilted optic disc and dome-shaped macula, polypoidal choroidal vasculopathy and SRD may occur, so appropriate treatment will be necessary.

Keyword

Anti-vascular endothelial growth factor; Dome-shaped macula; Polypoidal choroidal vasculopathy; Serous retinal detachment; Tilted optic disc

MeSH Terms

Angiography
Choroid*
Endothelial Growth Factors
Female
Hemorrhage
Humans
Indocyanine Green
Intravitreal Injections
Middle Aged
Polyps
Recurrence
Retinal Detachment*
Retinaldehyde*
Tomography, Optical Coherence
Endothelial Growth Factors
Indocyanine Green
Retinaldehyde

Figure

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  Figure 1 Fundus photography, optical coherence tomography (OCT) and fluorescein angiography at first visit. Fundus photography of right eye (A) and left eye (B) show bilateral tilted optic disc with inferonasal staphyloma and submacular hemorrhage in the right eye. Spectral domain optical coherence tomography (SD-OCT) of right eye (C: horizontal scan, D: vertical scan) shows subretinal hemorrhage and pigment epithelial detachment (PED) with dome-shape macula. SD-OCT of left eye (E) shows dome-shaped macula. Fluorescein angiography of right eye (F) shows blocked fluorescence due to subretinal hemorrhage. Indocyanine green angiography of right eye (G) shows branching vascular network (arrow) and circular polypoidal hyperfluorescent lesions (arrowheads) which corresponds with PED in SD-OCT (D).

• 

  Figure 2 Optical coherence tomography (OCT) and fluorescein angiography after intravitreal injection of C3F8 gas and aflibercept. After intravitreal injection of C3F8 gas and aflibercept and two additional monthly intravitreal injections of aflibercept, spectral domain optical coherence tomography (SD-OCT) of right eye (A) shows decreased subretinal hemorrhage and pigment epithelial detachment. At that time, SD-OCT of left eye (B) shows serous retinal detachment. Fluorescein angiography (C) and indocyanine green angiography (D) of left eye show no fluorescein leakage but show multiple hyperfluorescent dots and window defect due to atrophy of retinal pigment epithelium.

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  Figure 3 Mltiomodal imaging of dome shaped macula. At 4 months after first visit, fundus photography (A) and spectral domain optical coherence tomography (SD-OCT) of right eye (B) show recurrence of subretinal fluid (arrowhead) and elevated pigment epithelial detachment (arrow). After 1 month from additional intravitreal injection of aflibercept in the right eye, SD-OCT (C) shows slightly improved subretinal fluid and pigment epithelial detachment. SD-OCT of left eye (D) shows improved serous retinal detachment without treatment. 3D SD-OCT of right eye (E) and left eye (F) show dome-shaped macula. After 1 year from first visit, fluorescein angiography (G) and indocyanine green angiography (H) of right eye show that the branching vascular network is still the same but the circular polypoidal hyperfluorescent lesions have decreased.

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