Retinal Review: November 2023

October 26, 2023


A 55-year-old woman was referred for vision loss OS for two weeks. Ocular history is significant for moderate myopia OS > OD, PVD OU, and dry maculopathy due to myopia OS > OD. Vision has previously been 20/20 OU with stable maculas (see photos).


On examination VA was OD: 20/20 and OS: 20/40. The anterior segments were normal. DFE of the right eye showed a mildly myopic fundus but no significant abnormalities. In the left eye there was more pronounced myopic changes in the periphery and macula. Of note was macular hemorrhage and exudation (see photos and OCT).

On examination VA was OD: 20/20 and OS: 20/40.

Choroidal neovascularization is most commonly age related, but younger patients can develop CNVM in the context of high myopia, previous trauma, chorioretinitis, macular scars, angioid streaks, ocular histoplasmosis, and idiopathic. As opposed to the CNVM associated with AMD which typically is either below the RPE or incorporated into the RPE, CNVMs in younger patients can be smaller and above the RPE. As a result, they typically respond more favorably to injections and tend to recur less often. Our patient underwent two Avastin injections a month apart with complete resolution of the exudation and return to 20/20 vision (see photos). The leakage can recur, so the patient needs to be monitored, but as opposed to a wet AMD patient, recurrence is not a certainty. She will be evaluated periodically, use AREDS2 vitamins, and monitor with a weekly home Amsler grid.

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