Presumed Melanocytoma-Associated Choroidal Neovascular Membrane with Hemorrhage Successfully Treated with Intravitreal Aflibercept Injections

A patient presented with melanocytoma and associated choroidal neovascular membrane with hemorrhage involving the macula. The patient was treated with monthly aflibercept (Eylea) injections with significant improvement of best corrected visual acuity. In this report, we explore the development of a choroidal neovascular membrane (CNVM) formation in a patient with melanocytoma and the effect of intravitreal aflibercept (Eylea) on disease course. Case report study used patient data obtained from examination and imaging. The patient was treated with monthly intravitreal aflibercept injections leading to complete resolution of CNVM and hemorrhage, with significant improvement of best corrected visual acuity. Awareness and proper monitoring for the sequelae of melanocytoma are important for early detection and prevention of visually threatening outcomes. In cases of melanocytoma-associated CNVM formation with large subretinal hemorrhage, intravitreal aflibercept can be an effective tool for inducing CNVM regression and allowing improvement of visual acuity.

Management of Choroidal Neovascularization Associated with Optic Disc Melanocytoma with Intravitreal Aflibercept: A Case Report and Review of the Literature

Purpose

To report a rare case of melanocytoma associated choroidal neovascularization (CNV) treated with intravitreal aflibercept.

Methods

We reviewed the literature for the previous reports and different methods of treatment.

Results

Optic disc melanocytoma has been considered as a benign melanocytic tumor that rarely affects vision. There is evidence in the literature of association between choroidal neovascular membrane and disc melanocytoma.

Conclusions

In conclusion, our article provides a review of literature of such a rare association in which the ophthalmologists must be aware of its occurrence and possible ways of management.

Optic disk melanocytoma associated with polypoidal choroidal vasculopathy lesions, after combination treatment of photodynamic therapy and intavitreal aflibercept (Eylea), a case report

Background

We report a rare case of a woman with optic disk melanocytoma (ODMC) in conjunction with polypoidal choroidal vasculopathy (PCV). We also present, for the first time in literature, the clinical and morphological outcomes of the applied treatment, consisting of a session of photodynamic therapy (PDT) and three monthly intravitreal aflibercept injections.

Case presentation

An 83-year-old Greek woman, complaining for visual decline at her left eye, referred to our department and was diagnosed with ODMC associated with PCV. At presentation, best corrected visual acuity (BCVA) was 2/10, fundus examination revealed a pigmented lesion covering partially the optic nerve head and extending into the peripapillary choroid and retina, while hard exudates were observed temporal to it. Blocked hypofluorescence in the area covered by the lesion and diffuse hyperfluorescence at its temporal rim were shown by fluorescein angiography (FA). Indocyanine green angiography (ICGA) identified 3 hyperfluorescent polypoidal lesions arising from the choroidal vasculature. Optical coherence tomography (OCT) revealed subretinal fluid and retinal pigment epithelium detachment (RPE) at the region corresponding to polyps. The treatment included a PDT session combined with 3 monthly intravitreal aflibercept injections. Three months since the treatment initiation, new BCVA was 5/10, ICGA demonstrated total polyps occlusion, while OCT detected RPE detachment without subretinal fluid. Ten months later, ODMC was stable, BCVA rose to 7/10, no polyps were present, and total resolution of RPE detachment was achieved.

Conclusions

This is the first case report of PCV coexisting with ODMC, presenting both ICGA and OCT findings, and the applied treatment and its outcomes. Furthermore, we demonstrated that PDT combined with intravitreal aflibercept injections seems to be a promising treatment for PCV.

Choroidal neovascularization of optic disk melanocytoma treated with bevacizumab

PURPOSE

To report a case of choroidal neovascularization (CNV) associated with optic disk melanocytoma successfully treated with bevacizumab.

METHODS

A 63-year-old man complained of visual impairment in his left eye. His visual acuity was 0.9 OS. Fundus examination showed optic disk melanocytoma associated with serous retinal detachment and mild hemorrhage. Fluorescein and indocyanine green angiography revealed CNV adjacent to the optic disc. Intravitreous bevacizumab (IVB) was performed 3 times.

RESULTS

Choroidal neovascularization and serous retinal detachment disappeared at 5 months after IVB. Visual acuity recovered to 1.5 OS and has been stable for 1 year follow-up. No adverse events were found related to IVB.

CONCLUSIONS

Intravitreous bevacizumab can be a beneficial treatment for CNV associated with optic disc melanocytoma.

Nidek MP1 is able to detect subtle decline in function in inherited and age-related atrophic macular disease with stable visual acuity

PURPOSE

To investigate whether the Nidek MP1 microperimeter (NAVIS software Version 1.7; Nidek Technologies, Padua, Italy) can detect functional decline in progressive atrophic macular disease with stable visual acuity.

METHODS

Nine eyes of nine patients with stable acuity but progressive inherited or age-related atrophic macular disease evident on fundus autofluorescence imaging were reviewed. Each patient underwent 3 consecutive microperimetry tests at baseline, 6 months, and 12 months. Acuity, fixation, and microperimetry tests were performed at each visit. Changes in acuity, fixation stability, and macular sensitivity were analyzed. To detect regional change in retinal sensitivity, the test grid was divided into clusters based on either topographical or functional features. The mean sensitivities within each zone were also compared across the three visits.

RESULTS

In this cohort, there was no significant change in visual acuity, fixation stability, and macular sensitivity over 1 year. However, significant decline in mean sensitivity within the central macula and test loci adjacent to dense scotoma was found (P = 0.004 and 0.002, respectively). In contrast, mean sensitivity elsewhere remained stable.

CONCLUSION

The MP1 can detect significant change in regional retinal sensitivity within 12 months in patients with progressive atrophic macular disease and stable acuity. Individualized analysis of regional sensitivity may be a useful method for quantifying microperimetry.