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+A 73-year-old woman was initially referred 19 months prior to the current presentation, at which time fluorescein and indocyanine green angiography showed a medium-sized subfoveal classic CNV in the left eye, which had not been previously treated.
+She did not return for treatment until the current presentation, when she noted decreased vision in the left eye.
+The best-corrected visual acuity (BCVA) was 20/100.
+Slit lamp examination showed a small yellowish patch in the perifoveal region and retinal edema.
+Structural OCT revealed the retinal elevation, subretinal fluid and a hyper-reflective elongated area above RPE indicating type II CNV.
+Anti-angiogenic treatment with intravitreal aflibercept injections were administered with a treat-and-extend regimen.
+OCT angiograms (Fig.1) showed noticeable reduction in CNV flow area by 1–2 days post injection, with continued reduction at 1 week and 2 weeks.
+CNV flow area and vessel density were reduced, probably due to the decreased flow or temporary closure of the smaller anastomoses.
+Significant re-appearance of CNV was noticeable at 4 weeks after the first injection and again at 6 weeks after the second injection.
+The vascular pattern of the re-enlarged CNV (Fig.1A) was very similar to the initial pretreatment CNV, suggesting that the recurrence may be reopening of original channels rather than growth of new vessels.
+Comparing the CNV network prior to the 3rd injection to the baseline, it is notable that there were fewer smaller channels, while the larger caliber channels remained.
+Quantitative measurements from OCT angiography (Fig.2A) showed reduction in CNV flow area and flow index over the first 2 weeks with subsequent return.
+Retinal thickness (Fig.2B) showed the fluid resorption over the first 4 weeks in the first treatment cycle continuing at least 2 weeks into the second treatment cycle, at which time no fluid remained (Fig.1B).
+But fluid re-accumulated under the retina 6 weeks after the 2nd injection.
+Visual acuity (Fig.2B) continued to improve over the 3 treatment cycles.