OSLI Retina

December 2019

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796 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C A S E R E P O R T ■ Perifoveal Exudative Vascular Anomalous Complex With Suspended Scattered Particles in Motion Himanshu K. Banda, MD; Sabin Dang, MD; Richard J. Rothman, MD ABSTRACT: Perifoveal exudative anomalous com- plex (PEVAC) is an uncommon entity that occurs in isolation or in association with retinal vascular disorders. The authors describe a case of a 47-year- old man presenting with a central scotoma in the left eye found to have an isolated PEVAC. Fundus photography, optical coherence tomography (OCT), and intravenous fluorescein angiography were col- lected. OCT angiography of the lesion revealed sus- pended scattered particles in motion, a newly de- scribed finding in exudative macular retinopathies. The authors describe the first case of PEVAC with angiographic evidence of suspended scattered par- ticles in motion. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:796-800.] INTRODUCTION Perifoveal exudative anomalous complex (PE- VAC) is clinically defined by the presence of a unilateral, isolated, perifoveal aneurysm with sur- rounding exudation in an otherwise healthy pa- tient. 1 Multimodal imaging has described these lesions in detail. 2 Structural optical coherence to- mography (OCT) demonstrates PEVAC as round, hyperreflective lesions with a hyporeflective lu- men. OCT angiography (OCTA) shows a defined aneurysmal lesion with detectable flow in the su- perficial vascular plexus (SVP). 3 Suspended scattered particles in motion (SSPiM) is a newly described OCTA signal corresponding to hyperreflective intraretinal fluid (IRF) in exuda- tive retinopathies, including diabetic retinopathy (DR), retinal vein occlusion (RVO), and neovascu- lar age-related macular degeneration (AMD). 4 Areas of SSPiM have increased OCTA signal and appear as oval or circular regions of flow on cross-section- al and en face images. 5 The "suspended particles" seen on OCTA are suspected to be particulate in IRF, which eventually form hard retinal exudates. 6,7 We present, to our knowledge, the first case of PE- VAC exhibiting the OCTA finding of SSPiM. CASE REPORT A 47-year-old male presented with a 2-day his- tory of a painless scotoma in the left eye. He had no known medical problems, no history of chronic medication use, and no history ocular procedures or treatments. Best-corrected visual acuity was 20/20 in both eyes. Anterior segment exam was un- remarkable in both eyes. Fundus examination of the left eye showed a perifoveal aneurysm with a surrounding ring of exudation and IRF (figure 1). IVFA demonstrated an early hyperfluorescence corresponding with IRF (Figure 2A) and a late, discrete punctate area of leakage defining the aneurysmal lesion (Figure 2B). OCT showed a hyperreflective perifoveal aneu- rysmal lesion with a hyporeflective lumen (Figure 2A) and associated cystic IRF (Figure 2B). Discreet hyperreflective opacities representing exudates can also be seen on OCT. OCTA B-scans with flow revealed an isolated dila- tation matching the PEVAC lesion with detectable flow in the SVP (Figure 3). En face imaging of the SVP dem- onstrates a poorly defined flow signal that represents From The Retina Institute, St. Louis, Missouri. Originally submitted March 23, 2019. Revision received March 23, 2019. Accepted for publication June 11, 2019. The authors report no relevant financial disclosures. Address correspondence to Richard J. Rothman, MD, 1600 S. Brentwood Blvd., Suite 800, St. Louis, MO 63144; email: mdrothman.richardj@rc-stl.com. doi: 10.3928/23258160-20191119-08

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