Delta Journal of Ophthalmology

RETINAL IMAGING SECTION
Year
: 2016  |  Volume : 17  |  Issue : 1  |  Page : 47--48

A choroidal neovascular membrane hidden under a pigment epithelial detachment


Alaa M Fadel, Moemen S Elnawawy 
 Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
Alaa M Fadel
Department of Ophthalmology, Faculty of Medicine, Alexandria University, 9 Victor Bassily Street, 02061 Alexandria
Egypt

Abstract

Pigment epithelial detachment occurs mainly in age-related macular degeneration and central serous chorioretinopathy and in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders. A tomographic notch is an optical coherence tomography finding that might indicate the presence of an occult choroidal neovascularization.



How to cite this article:
Fadel AM, Elnawawy MS. A choroidal neovascular membrane hidden under a pigment epithelial detachment.Delta J Ophthalmol 2016;17:47-48


How to cite this URL:
Fadel AM, Elnawawy MS. A choroidal neovascular membrane hidden under a pigment epithelial detachment. Delta J Ophthalmol [serial online] 2016 [cited 2022 Jul 5 ];17:47-48
Available from: http://www.djo.eg.net/text.asp?2016/17/1/47/178777


Full Text

A 45-year-old male patient presented with metamorphopsia in the left eye since 2 weeks.

He was not diabetic or hypertensive. His visual acuity was 1.0 in the right eye with −2.0/−2.5΄90 glasses, and 0.5 in the left with 1.5/−2.0΄90 in the left eye. Examination of the right eye revealed normal anterior and posterior segments. Examination of the left eye revealed a clear cornea and lens, clear vitreous, and yellowish spots in the macular area [Figure 1].{Figure 1}

Fluorescein angiography was carried out for both eyes, revealing hyperfluorescence of the yellowish spots found in the posterior pole, with an increase in the intensity but not in size toward the end of the angiographic phases on the temporal edge of the foveal avascular zone [Figure 2]. Angiogram of the right eye was free.{Figure 2}

An optical coherence tomography scan was ordered for the left eye, revealing a normal foveal contour and normal macular thickness as compared with age-related normal individuals, with a double-humped retinal pigment epithelial detachment [Figure 3].{Figure 3}

This tomographic notch warranted a further indocyanine green study of the same eye, which revealed a rounded hypercyanescent patch that increased in intensity and in size toward the end of the angiography. The diagnosis of an occult choroidal neovascular membrane was established [Figure 4] and [Figure 5].{Figure 4}{Figure 5}

 Background



The retinal pigment epithelium monolayer, extending from the optic disk margin continuously into the ciliary body epithelium, is bounded on its apical surface by the apical surface of the retina and on its basal surface by the collagenous layer of Bruch's membrane [1]. Retinal pigment epithelium detachment is a blister-like elevation seen on optical coherence tomography scans and is a prominent feature of many chorioretinal disease processes, the most prevalent of which is age-related macular degeneration. It is also seen in central serous chorioretinopathy and in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders [2]. Pigment epithelial detachments are divided into drusenoid, serous, vascularized, or mixed categories.

One or more signs of occult neovascularization usually accompany large serous detachments of the retinal pigment epithelium occurring in patients older than 50 years of age. Evidence has been presented that a flattened or notched border of these detachments is a frequently encountered and an important biomicroscopic and fluorescein angiographic sign of hidden choroidal neovascular complex, most of which lies outside the area of the serous detachment of the pigment epithelium [3].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Zayit-Soudry S, Moroz I, Loewenstein A. Retinal pigment epithelial detachment. Surv Ophthalmol 2007; 52:227-243.
2Mrejen S, Sarraf D, Mukkamala SK, Freund KB. Multimodal imaging of pigment epithelial detachment: a guide to evaluation. Retina 2013; 33:1735-1762.
3Gass JD. Serous retinal pigment epithelial detachment with a notch. A sign of occult choroidal neovascularization. Retina. 1984; 4:205-220.