Abstract
Purpose The purpose of this case report is to present the findings of optical coherence tomography angiography (OCTA) of a patient with bilateral choroidal neovascularization (CNV) associated with optic disc drusen (ODD), who was treated with intravitreal aflibercept injection. Case presentation. A 14-year-old girl presented with a complaint of visual loss and metamorphopsia in her both eyes. Best-corrected visual acuity (BCVA) was 20/32 and 20/25, respectively, in the right and left eyes. Intraocular pressure and anterior segment examination were normal. Dilated fundus examination revealed elevated optic discs with blurred margins in both eyes. In addition, slightly elevated yellow lesion extending from optic nerve head to the macula was observed bilaterally. The patient underwent imaging with colour fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), spectral-domain optic coherence tomography (SD-OCT), OCTA, orbital ultrasonography (USG), and computed tomography (CT). In particular, OCTA demonstrated clearly the large circular CNV complex in the right eye and the CNV structure in the left eye containing slightly activated main trunk and minimal vessel loops in the papillomacular region. CNV secondary to bilateral ODD was suspected. Intravitreal aflibercept injections were performed in 3 doses to the right eye and a single dose to the left eye. After the injections, BCVA reached its complete level in both eyes. SD-OCT revealed irregularity of RPE in the temporal region of the optic disc and complete regression of the subretinal fluid. Interestingly, the entire CNV complex including the main trunk completely disappeared in OCTA. CNV complex was not observed in OCTA during 1-year follow-up, and peripapillary and macular vascular density measurements did not show any significant change. BCVA was preserved, and no additional injections were needed. Conclusion It is possible that OCTA can be used for detailed evaluation of CNV associated with ODD, response to anti-VEGF treatment, and peripapillary and macular vascular density. There is a need for further studies to confirm the changes such as disappearance of CNV in OCTA after injection as we observed in our patient.
Highlights
Optic disc drusen (ODD) are calcified hyaline-like deposits in the optic nerve head that are mainly located in front of the lamina cribrosa
Various imaging methods have been used in order to detect ODD accurately and reliably, which include ultrasonography (USG), enhanced depth imaging-OCT (EDIOCT), fluorescein fundus angiography (FFA), and fundus autofluorescence (FAF), and the newest application is optical coherence tomography angiography (OCTA, Optovue, Inc., Fremont, CA, USA) [2]
The patient underwent imaging with colour fundus photography, FAF, FFA, spectral-domain optic coherence tomography
Summary
Optic disc drusen (ODD) are calcified hyaline-like deposits in the optic nerve head that are mainly located in front of the lamina cribrosa They are often bilateral (67%-91%), and their incidence is 0.4%-20.4% in general population while there is female preponderance in their prevalence. Noninvasive imaging of the retina, choroidal, and disc microvasculature is possible with OCTA and without the use of exogenous intravenous dye injection It can provide information for the evaluation of both structure and blood flow. To the best of our knowledge, only Ong et al demonstrated inactivate CNV associated with ODD in 1 case with OCTA in a series of 8 paediatric patients with CNV This is the first time to report an interesting change in CNV after injection and long-term follow-up findings
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