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.