Argus II retinal prosthesis for retinitis pigmentosa in the Middle East: The 2015 Pan-American Association of Ophthalmology Gradle Lecture.

BACKGROUND: To describe the outcomes of patients with retinitis pigmentosa (RP) who received the Argus II Retinal Prosthesis System. METHODS: This retrospective, interventional case series evaluated 10 consecutive patients who received the Argus II retinal implant and underwent visual function tests with the system on and system off. The main outcome measures were safety (the number, seriousness, and relatedness of adverse events), and visual function measured by computer-based objective tests, including square localization (SL) and direction of motion (DOM). Secondary measures included functional vision performance, including orientation and mobility (O&M) tasks. RESULTS: There were no intraoperative complications and all prostheses remained implanted at the end of follow up. The mean patient age was 41.3 years; mean duration of the implant in vivo was 2.1 years. One patient had a suture exposure over the coil suture tab and over the inferior case suture tab at 2 years postoperatively, which was managed successfully. One patient developed mild vitreous hemorrhage that resolved spontaneously. One patient developed high intraocular pressure postoperatively due to a tight scleral band (SB) that was managed successfully. Patients performed significantly better with the Argus II system on than off on all tasks. CONCLUSION: Patients who received the Argus II had a safety profile out to 4 years post-implantation that was markedly better than that observed in the pre-approval phase of the Argus II. In this population of RP patients, the Argus II retinal prosthesis provided useful visual function over several years that likely translates into improved quality of life. TRIAL REGISTRATION: clinicaltrials.gov identifier, NCT00407602.

Adult presentation of retinoblastoma in Saudi patient.

To describe an unusual case of retinoblastoma in adult Saudi. A 21-year-old Saudi male developed acute unilateral visual loss due to a large intraocular lesion in his left eye. Within five days of presentation, the tumor enlarged rapidly causing angle closure glaucoma and orbital cellulitis like picture. The patient underwent enucleation and the histopathology specimen confirmed the presence of an undifferentiated type tumor cell that was consistent with retinoblastoma with choroidal and optic nerve invasion. Retinoblastoma should be considered in the differential diagnosis of an intraocular mass in adults. To the best of our knowledge, this is the first reported case of an adult presentation of retinoblastoma in Saudi patient.

Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial.

PURPOSE: To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS: This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS: A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P = .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P = .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P = .0001). Mean surgical time was 71.3 ± 32.1 minutes in the study group and 83.6 ± 38.7 minutes in the control group (P = .061). CONCLUSION: Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Outcomes of Pneumatic Retinopexy for the Management of Rhegmatogenous Retinal Detachment at a Tertiary Care Center.

PURPOSE: The purpose of the study was to report the outcomes of pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). METHODS: A retrospective chart review of all patients with RRD who were managed with PR at the King Khaled Eye Specialist Hospital between 2000 and 2014. Data were collected on preoperative ocular history, characteristics of the RRD, postoperative anatomical and visual outcomes, and secondary surgeries. RESULTS: Sixty-five eyes comprised the study sample with mean a follow-up of 42 months. Eighteen (27%) eyes had a history of ocular surgery and 5 (7.6%) had previous ocular trauma. Thirty-nine (60%) eyes had macula on RRD. Retinal detachment (RD) was caused by a single break in fifty (76.9%) eyes. Superior breaks were found in 56 (86.1%) eyes. Twelve (18%) eyes had posterior vitreous detachment. Fifty-one (78.5%) eyes underwent PR under local anesthesia and 9 (13.8%) underwent conjunctival peritomy. Octafluoropropane gas was used in 49 (75.4%) eyes and sulfur hexafluoride in 16 (24.6%) eyes. Cryotherapy was performed in 48 (73.8%) eyes and only laser photocoagulation in 8 (12.3%) eyes. Nine (13.8%) eyes underwent both cryotherapy and laser photocoagulation. Primary anatomical healing was achieved in 45 (69.2%) eyes, of which 20 (30.8%) required a second intervention. The final anatomical outcome was achieved in 100% of the eyes. At final visit, vision improved in 72% of eyes, was maintained in14.5%, and decreased in 9.7% (6). CONCLUSION: PR is a safe procedure for RRD repair. The final anatomical outcome was excellent in all cases including the recurrent RD after primary failure.

Incidence of Endophthalmitis after Intravitreal Anti-vascular Endothelial Growth Factor: Experience in Saudi Arabia.

PURPOSE: To report the incidence of endophthalmitis, the clinical and microbiological aspects, after intravitreal (IVT) injection of anti-vascular endothelial growth factor. METHODS: A chart review was performed of patients diagnosed with endophthalmitis after receiving IVT injections of bevacizumab (Avastin) and ranibizumab (Lucentis) presenting to King Khaled Eye Specialist Hospital (KKESH) from May 2006 to December 2012. Endophthalmitis was diagnosed clinically as an intraocular infection with vitreous involvement that required treatment with IVT antibiotics or had undergone pars plana vitrectomy (PPV) to remove the suspected microorganism. Main outcome measures were the incidence of endophthalmitis and the clinical and microbiological features. RESULTS: Seven cases of endophthalmitis were identified, there was 1 (0.004%) case of endophthalmitis of 22674 IVT injections performed at KKESH. All cases were after IVT bevacizumab. Three (42.85%) cases were culture-positive and caused by Staphylococcus epidermidis. The initial management was vitreous tap and IVT injection of antibiotics followed by PPV in 6 (85.7%) cases. One (14.3%) case underwent evisceration. Visual acuity improved at last visit in only 2 (28.6%) cases. The rate of endophthalmitis was 0.0004% for bevacizumab. CONCLUSIONS: The rate of endophthalmitis after IVT bevacizumab and ranibizumab was very low. We recommend following a standardized injection protocol, adherence to sterile techniques, and proper patient follow-up are determinant factors for low incidence rates. In addition, endophthalmitis after IVT bevacizumab and ranibizumab have poor visual outcomes despite prompt treatment.

Rhegmatogenous retinal detachments associated to Stickler syndrome in a tertiary eye care center in Saudi Arabia.

PURPOSE: To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD) in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy. PATIENTS AND METHODS: Chart review of 70 eyes (62 patients). Incidence of RRD, postoperative visual acuity, and risk factors were evaluated. RESULTS: Twenty-two patients (35%) had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8%) of patients had successful surgery (including second surgery). Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027). Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P<0.001); preoperative cataract (P=0.023); and proliferative vitreoretinopathy (P<0.001). RRD developed in 16/44 eyes despite laser prophylaxis. CONCLUSION: Prophylactic retinopexy was not beneficial for Stickler syndrome patients. Success of primary surgery for RRD remains low. The primary surgery should be vitrectomy combined with scleral buckling and silicone oil tamponade.

Spectral-domain optical coherence tomography reveals prelaminar membranes in optic nerve head pallor in eyes with retinitis pigmentosa.

PURPOSE: To determine the relationship between prelaminar structural changes of the optic nerve head (ONH) and optic nerve waxy pallor in retinitis pigmentosa (RP) using spectral-domain optical coherence tomography (SD-OCT) and fundus photography. METHODS: An observational cross-sectional case control study of patients with RP with and without ONH waxy pallor and controls. Subjects underwent clinical examination, fundus photography, and SD-OCT raster imaging of the ONH. Four independent specialists reviewed the images in a masked fashion. RESULTS: Fifty-five eyes of 31 subjects with RP and 28 eyes of 14 controls were included. Optic nerve head waxy pallor was seen in 29 RP eyes (52.7 %) and none in controls. SD-OCT showed a hyper-reflective structure suggestive of a glial membrane-like structure on the surface of ONH in 16 of RP eyes (55.1 %). In the RP group, there was a significant positive correlation between the ONH pallor and the presence of a prelaminar structure (p = 0.006). CONCLUSIONS: There is a presence of glial membrane-like structures on the optic nerve head surface in eyes with RP compared to healthy eyes. As the presence of glial membranes correlated with the presence of ONH waxy pallor, in such cases these membranes might be responsible for ONH waxy pallor.

Peripherin mutations cause a distinct form of recessive Leber congenital amaurosis and dominant phenotypes in asymptomatic parents heterozygous for the mutation.

BACKGROUND: Dominant mutations in peripherin (PRPH2) are associated with a spectrum of retinal dystrophy phenotypes, many of which are adult onset and involve the macula. Recessive PRPH2 mutations cause retinal dystrophy associated with prominent maculopathy in adulthood; however, the presenting childhood phenotype has not been defined. We characterise this phenotype. METHODS: Retrospective case series of families harbouring bi-allelic PRPH2 mutations (2010-2014). RESULTS: Three children (two families; assessed at 2 years old) and two adults (one family; assessed at 24 and 35 years old) with homozygous PRPH2 mutations (c.497G>A (p.Cys166Tyr) or c.136C>T (p.Arg46*)) all had infantile nystagmus and decreased vision noted soon after birth and a history of staring at lights during infancy (photophilia). The three children had high hyperopia, a normal or near normal fundus, and non-recordable electroretinographies (ERGs). The two adults had slight myopia, macular and peripheral retinal changes, and non-recordable ERGs. All five available carrier parents had macular±peripheral retinal findings, although they considered themselves asymptomatic except for one mother who had developed visual loss in one eye at 48 years old and had an associated subfoveal lesion. CONCLUSIONS: Bi-allelic PRPH2 mutations cause a distinct Leber congenital amaurosis phenotype in infancy; affected adults have prominent maculopathy. Heterozygous parents can be asymptomatic but have clinically obvious macular phenotypes with or without peripheral retinal findings, which can be helpful in making the genetic diagnosis in affected children. The difference between the heterozygous and homozygous phenotypes is likely related to gene product dosage effect.

Endophthalmitis Trends and Outcomes Following Glaucoma Surgery at a Tertiary Eye Care Hospital in Saudi Arabia.

PURPOSE: To compare the incidence, microbial profile, management and outcomes of endophthalmitis after glaucoma drainage implant (GDI), or trabeculectomy over 2 separate time periods before and after the year 2000. METHODS: A chart review was performed for patients with endophthalmitis after trabeculectomy (trabeculectomy group) or GDI group between 1983 to 1999 (group 1) and 2000 to 2011 (group 2) at a tertiary care hospital. Data were compared between groups and time periods. RESULTS: There were 56 cases of endophthalmitis after trabeculectomy in group 1 and 17 cases in group 2. After GDI, there were 10 cases of endophthalmitis in group 1 and 1 case in group 2. The incidence of endophthalmitis after GDI decreased significantly from 0.0105% to 0.00074% in groups 1 and 2, respectively (P<0.05). The incidence of endophthalmitis decreased significantly after trabeculectomy from 0.007% in group 1 to 0.00197% in group 2 (P=0.0004). There were 26 culture-positive cases in group 1 and 10 in group 2. The most common isolates were Streptococcus species in group 1 and Staphylococcus species in group 2. Indicators of morbidity were lower in group 2. The final visual outcome in either group was not correlated to the type of surgery, microbes, or initial management. CONCLUSIONS: There was a greater incidence of endophthalmitis after trabeculectomy compared with GDI. The incidence of endophthalmitis decreased from 2001 to 2011 compared with 1983 to 1999, which is likely due to advances in surgical technique. However, significant visual morbidity does occur despite prompt treatment.

Endophthalmitis Caused by Rhizobium radiobacter After Posterior Chamber Phakic Intraocular Lens Implantation to Correct Myopia.

PURPOSE: To describe a 29-year-old man presenting with acute-onset endophthalmitis caused by Rhizobium (formerly Agrobacterium) radiobacter after uneventful implantable collamer lens implantation for myopia. METHODS: Case report. RESULTS: The patient was treated with intravitreal injections of vancomycin and ceftazidime, as well as topical and systemic antibiotics. The patient had a good response with a final visual acuity of 20/50 at the last follow-up visit 25 months postoperatively. CONCLUSIONS: This case represents the first case report of endophthalmitis caused by Rhizobium radiobacter following implantable collamer lens implantation.

High-power handheld blue laser-induced maculopathy: the results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group.

PURPOSE: To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser. DESIGN: Consecutive case series. PARTICIPANTS: Fourteen eyes of 14 patients. METHODS: Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. MAIN OUTCOME MEASURES: Analysis of the types of maculopathy and vitreoretinal pathologic features. RESULTS: All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub-internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300). CONCLUSIONS: Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.

Combined therapy for diabetic macular edema.

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. The management of DME is complex and often multiple treatment approaches are needed. This review demonstrates the benefits of intravitreal triamcinolone, bevacizumab and ranibizumab as adjunctive therapy to macular laser treatment in DME. The published results indicate that intravitreal injections of these agents may have a beneficial effect on macular thickness and visual acuity, independent of the type of macular edema that is present. Therefore, pharmacotherapy could complement focal/grid laser photocoagulation in the management of DME. For this review, we performed a literature search and summarized recent findings regarding combined therapy for DME.

Rhegmatogenous retinal detachment in children 16 years of age or younger.

PURPOSE: To study the anatomical and visual outcomes and prognostic factors that may predict the outcomes of rhegmatogenous retinal detachment (RRD) in children. METHODS: A retrospective chart review was performed for patients 16 years of age or younger who underwent retinal reattachment surgery for RRD at the King Abdulaziz University Hospital from 1996 to 2005 and the King Khalid Eye Specialist Hospital from 2002 to 2006, Riyadh, Saudi Arabia. Good visual outcome was defined as ≥20/200. The association between two categorical variables was evaluated with the Chi-squared test or the exact test, as appropriate. Predictors for RRD and good final visual acuity were identified by conducting stepwise logistic regression analysis. P < 0.05 was statistically significant. RESULTS: The study population comprised 148 patients (166 eyes). There were 104 (70%) males and 44 (30%) females. Mean age at presentation was 8.33 ± 3.26 years (range 1.5-16 years). The retina was reattached after one surgical procedure in 106 (63.8%) eyes and reattached in 130 (78.3%) eyes after multiple surgeries. Factors predicting recurrence after the first surgery were myopia (P = 0.028), proliferative vitreoretinopathy (PVR) at presentation (P = 0.024), and total retinal detachment (P = 0.032). Good final visual outcome was achieved in 60 (44.4%) eyes. Predictors of good visual acuity were: good visual acuity at presentation (P < 0.001); absence of PVR at presentation (P < 0.001); one quadrant of retinal detachment (P = 0.0024); macula on (P = 0.0107); absence of primary repair of a ruptured globe (P = 0.0059); no pars plana vitrectomy (PPV) (P = 0.0123); clear phakic lens at follow-up (P < 0.001); absence of postoperative complications (P < 0.001); absence of recurrence of RRD (P < 0.001); and absence of epiretinal membrane (P = 0.0088). Logistic regression analysis indicated that recurrence of RRD was associated with myopia and previous congenital cataract surgery; good final visual outcome was associated with macula on detachment and poor visual outcome was associated with recurrence of RRD and occurrence of postoperative complications and previous repair of a ruptured globe. CONCLUSION: RRD in children is usually associated with a predisposing factor, a high rate of PVR, and total retinal detachment. Despite late diagnosis and the presence of PVR, favorable anatomical and visual outcomes can be achieved.

Long-term follow-up of choroidal neovascularization secondary to angioid streaks: case series and literature review.

BACKGROUND: The purpose of this paper is to report the clinical course of choroidal neovascularization (CNV) secondary to angioid streaks and the outcomes in response to different treatment modalities. METHODS: This was a case series of two consecutive patients (four eyes) with CNV secondary to angioid streaks. Visual acuity, ophthalmological examination, color photographs, fluorescein angiography, and optical coherence tomography were used to assess the outcomes of treatment. RESULTS: Two eyes were treated with photodynamic therapy for subfoveal choroidal neovascular membrane, one eye underwent thermal laser photocoagulation for extrafoveal CNV followed by intravitreal bevacizumab for subfoveal CNV, and one eye underwent intravitreal bevacizumab for subfoveal CNV. The follow-up period was 4-6 years. The final visual acuities of all eyes were 20/300 or worse with large submacular fibrosis. CONCLUSION: CNV secondary to angioid streaks in these two patients had a poor prognosis despite undergoing different types of treatment. Poor outcome was likely related to frequent recurrence and newly developed CNV, which remained a clinical concern in these cases.

Acute retinal necrosis after Boston type I keratoprosthesis.

A case report of a 68-year-old male who developed acute retinal necrosis (ARN) after Boston type I keratoprosthesis is presented. The procedure was performed for multiple graft failure secondary to herpetic keratitis. Clinical data including visual acuity, color fundus photography, fluorescein angiography, laboratory tests findings, and management are presented. After exclusion of other causes by laboratory workup, the patient was diagnosed with ARN most likely secondary to herpetic infection. Intravenous acyclovir and oral prednisolone were administered to the patient resulting in marked improvement in visual acuity and regression in the size of the retinitis. The patient eventually developed a soft eye and choroidal detachment with light perception vision. In patients with a history of herpetic keratitis or keratouveitis, it is highly advisable to maintain prophylactic systemic antiviral treatment before and after any ocular procedure such as the Boston keratoprosthesis.

Retinal detachment after laser in situ keratomileusis.

PURPOSE: To report characteristics and outcome of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for myopia. MATERIALS AND METHODS: A retrospective chart review of patients who presented with RRD after myopic LASIK over a 10-year period. RESULTS: Fourteen eyes were identified with RRD. Of these, two of 6112 LASIK procedures were from our center. The mean age of patients with RRD was 35.43 years. The mean interval of RRD after LASIK was 37.71 months (range, 4 months to 10 years). The macula was involved in eight eyes and spared in six eyes. Retinal breaks included a macular hole in two eyes, and giant tear in two eyes. Multiple breaks (>2 breaks) occurred in 6 cases. Pars plana vitrectomy (PPV) was performed in 3 (21.4%) eyes, a scleral buckle (SB) was performed in 4 (28.5%) eyes and 7 (50%) eyes underwent combined PPV and SB. Mean follow-up was 15.18 months (range, 1 month to 7 years). The retina was successfully attached in all cases. The final visual acuity was 20/40 or better in 7 (50%) eyes, 20/40 to 20/60 in 4 (28.5%) eyes, and 20/200 or less in 3 (21.4%) eyes. Poor visual outcome was secondary to proliferative vitreoretinopathy, epiretinal membrane, macular scar and amblyopia. CONCLUSION: The prevalence of RRD after LASIK was low at our institute. Anatomical and visual outcomes were acceptable in eyes that were managed promptly. Although there is no cause-effect relationship between LASIK and RRD, a dilated fundus examination is highly recommended before and after LASIK for myopia.

Characteristics of optic disc melanocytomas presenting with visual dysfunction.

OBJECTIVE AND DESIGN: A retrospective review study was designed to describe five cases of optic disc melanocytomas with tumor-related visual impairment. PARTICIPANTS: Five patients with optic disc melanocytoma presented with visual complaints to a tertiary eye hospital in Saudi Arabia. MATERIALS AND METHODS: Demographic and clinical data were analyzed, including the results of ocular examination, lesion laterality, best-corrected Snellen visual acuity, pupillary reflex, visual field testing, color fundus photography, fundus fluorescein angiography, and ophthalmic ultrasound. RESULTS: Visual dysfunction secondary to optic disc melanocytoma was identified. Case 1 had macular star edema with mild tumor enlargement, Case 2 had optic atrophy, Case 3 had juxtapapillary choroidal neovascular membrane with macular involvement, Case 4 had optic disc swelling with an enlarged blind spot, and Case 5 had a large altitudinal visual field defect. CONCLUSION: Although melanocytomas of the optic disc tend to have a benign behavior with slow evolution and stable vision, they may adversely affect visual function through a variety of mechanisms.

Bilateral retinal detachment after laser in situ keratomileusis.

A 37-year-old man developed retinal detachment after laser in situ keratomileusis (LASIK) in both eyes. Causes for the retinal breaks were a horseshoe tear and a giant tear. Both eyes were treated by vitrectomy and scleral buckle. Four months later, the patient developed a recurrent detachment in the right eye with cataract that was managed surgically. Both retinas were flat after a 20-month follow-up period. Bilateral rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication. Previous reports of retinal detachments after LASIK and possible related mechanisms were also reviewed.

Idiopathic polypoidal choroidal vasculopathy in a young man: case report and literature review.

PURPOSE: To report a case of idiopathic polypoidal choroidal vasculopathy and its angiographic characteristics in a young man. METHOD: Clinical data including visual acuity, color fundus photography, fluorescein angiograph and indocyanine green findings and management of this case are presented. RESULTS: A young healthy male was presented with sudden loss of vision in the left eye for 3 weeks duration and a visual of 1/200. Fundus examination of the eye showed vitreous hemorrhage with massive sub retinal yellowish old blood in the posterior pole with epiretinal fresh blood on the fovea. Intra-venous Fluorescein angiography and Indocyanine green tests showed features of Idiopathic Polypoidal Choroidal Vasculopathy. The patient received photodynamic therapy twice without significant visual improvement. CONCLUSION: Idiopathic Polypoidal Choroidal Vasculopathy can occur in a young age group and can lead to severe visual impairment despite treatment with PDT.