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Non-central CNV with central CME case report

Eighty-one years old phakic, his right eye has a subretinal disciform scar with hand motion vision, complains of sudden reduction of vision of his left eye to 20/50.

Clinical examinations show cystoid macular edema with subretinal fluids, off-center subretinal mass formation, and RPE alternation.


Optical coherence tomography 


OCT cross-section shows thinning of the choroid with RPE alternation and non-central subretinal amorphous material resembling choroidal neovascular membrane with subretinal fluids and cystoid changes in the outer retinal tissues in the center of the macula.


The upper OCT cross-section shows subretinal hyper reflective material with subretinal and intraretinal fluids the other post treatment cross-section shows resolution of subretinal and intraretinal fluids with subretinal hyper reflective material reducing in size leaving small scar
The upper OCT cross-section shows subretinal hyper reflective material with subretinal and intraretinal fluids the other post treatment cross-section shows resolution of subretinal and intraretinal fluids with subretinal hyper reflective material reducing in size leaving small scar  


Management 


The patient managed three consecutive intravitreal injections of Aflibercept monthly, which successfully improved vision to 20/25.


OCT shows resolved macular edema, subretinal fluid and reduced the neovascular membrane's size, leaving a small non-central subretinal scar with an intact ellipsoid zone centrally.


Discussion


The subretinal choroidal neovascular membrane can severely damage the ellipsoid zone and cause permeant visual loss, even after treatment.


Another independent factor for reducing vision is an intraretinal cystic formation, which holds a bad prognosis.


This patient was treated promptly, which helped reduce both the injury to the central ellipsoid zone and intraretinal tissues.


Vision restored as treatment held the progression of the non-central choroidal neovascular membrane to central.


Please check Clinical guidelines for ARMD 


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