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

A choroidal neovascular membrane hidden under a pigment epithelial detachment


Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Date of Submission01-Nov-2015
Date of Acceptance24-Dec-2015
Date of Web Publication16-Mar-2016

Correspondence Address:
Alaa M Fadel
Department of Ophthalmology, Faculty of Medicine, Alexandria University, 9 Victor Bassily Street, 02061 Alexandria
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-9173.178777

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  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.

Keywords: choroidal neovascularization, retinal pigment epithelium, tomographic notch


How to cite this article:
Fadel AM, Elnawawy MS. A choroidal neovascular membrane hidden under a pigment epithelial detachment. Delta J Ophthalmol 2016;17:47-8

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 2020 Oct 31];17:47-8. Available from: http://www.djo.eg.net/text.asp?2016/17/1/47/178777

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: Multiple yellowish spots in the macular area.

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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: A hyperfluorescent patch on the temporal edge of the foveal avascular zone (FAZ ).

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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: A tomographic notch is seen on optical coherence tomography (OCT ).

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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: Early hypercyanescence of the lesion in early phases of indocyanine green (ICG) angiography.

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Figure 5: Late increase in intensity and size in late phases of indocyanine green (ICG) angiography.

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  Background Top


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 Top

1.
Zayit-Soudry S, Moroz I, Loewenstein A. Retinal pigment epithelial detachment. Surv Ophthalmol 2007; 52:227-243.  Back to cited text no. 1
    
2.
Mrejen S, Sarraf D, Mukkamala SK, Freund KB. Multimodal imaging of pigment epithelial detachment: a guide to evaluation. Retina 2013; 33:1735-1762.  Back to cited text no. 2
    
3.
Gass JD. Serous retinal pigment epithelial detachment with a notch. A sign of occult choroidal neovascularization. Retina. 1984; 4:205-220.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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