Case Report: Complete tomographic resolution of focal choroidal excavation complicated with choroidal neovascularization after anti-VEGF treatment.

Purpose We report a case of focal choroidal excavation (FCE) that resolved after intravitreal injection of anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) and we describe its tomographic features. Case report A 43-year-old female presented with blurred vision and metamorphopsia in her left eye (LE) evolving for 10 years. The best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the LE. Fundus examination revealed the presence of a yellowish foveal lesion which corresponded to a conforming FCE associated to a pachychoroid on swept-source optical coherence tomography (OCT). The OCT-Angiography showed a foveal flow void in the choriocapillaris layer corresponding to the FCE area. Three years later, the patient complained of visual impairment, more metamorphopsia with a BCVA of 20/80 on her LE. The OCT showed intraretinal fluid with a foveal retinal pigment epithelium (RPE) detachment. The OCT-angiography confirmed the presence of CNV. Two months after one intravitreal bevacizumab injection, the OCT documented the complete resolution of macular edema, the regression of the CNV tissue and the restoration of a normal aspect of the fovea without any FCE. Her BCVA improved to 20/32 with resolution of the metamorphopsia. The OCT aspect remained stable during 3 years of follow-up. Conclusion CNV can develop in FCE and anti-VEGF therapy is a good option treatment. After treatment, FCE pattern can change et may completely resolve.

Retinal vein occlusions: an OCT- Angiography analysis.

AIM: To analyze microcirculatory abnormalities, central avascular area and capillary density in OCT-angiography in retinal venous occlusions (RVO). METHODS: This is a descriptive study of 35 patients (35 eyes) with RVO who consulted at the  ophthalmology department of Farhat Hached Hospital in Sousse between January 2014 and July 2018. The diagnosis of retinal venous occlusion was established on clinical examination, fundus photography and fluorescein angiography. All patients underwent OCT-angiography and OCT B-scan. RESULTS: Our study includes a total of 35 patients (35 eyes). Of these patients, 20 (57.1%) had branch retinal vein occlusion and 15 (42.8%) had central retinal vein occlusion. The loss or rarefaction of the capillary plexus concerned the deep capillary plexus (DCP) more than the superficial one (SCP). This rarefaction was observed in 25 eyes (71.42%) in both DCP and SCP. The widening of the central avascular zone and the rupture of the peri-foveolar anastomotic mesh were better or as visible as fluorescein angiography. Vascular tortuosity was easy to analyze and was more evident in the SCP than the DCP. Twenty-six (74.28%) patients had vascular tortuosity in DCP and 30 patients (85.71%) had this vascular tortuosity in SCP. Capillary dilatation and microaneurysms were better visible in the DCP than the SCP. These vascular abnormalities were found in 26 cases (74.28%) in the DCP and in 17 cases (48.57%) in the SCP. CONCLUSIONS: OCT-A is a non-invasive examination that allows very precise analysis and follow-up of both macular edema and superficial and deep capillary plexus architecture during retinal vein occlusions.