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Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 449-452

Refractory perifoveal exudative vascular anomalous complex like lesion responding to intravitreal dexamethasone implant: A therapeutic challenge

1 Vitreoretinal Services, Aradhana Eye Institute, Trivandrum, Kerala, India
2 Vitreoretinal Services, Chaithanya Eye Hospital and Research Institute; Department of Research, Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, Kerala, India

Correspondence Address:
Jay Sheth
Clinical Research Lead, Chaithanya Eye Hospital and Research Institute, Trivandrum - 695 004, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1000_21

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A 66-year-old male patient presented with the right eye (OD) decreased vision for 1 month duration. His best-corrected visual acuity (BCVA) was 6/36 in OD and 6/6 in the left-eye (OS). He had bilateral non-proliferative diabetic retinopathy (NPDR) changes with the presence of a large perifoveal aneurysmal lesion, which was diagnosed as perifoveal exudative vascular anomalous complex (PEVAC)-like lesion based on clinical evaluation, spectral domain optical coherence tomography (SD-OCT), and fundus fluorescein angiography (FFA). The patient underwent three intravitreal ranibizumab injections with minimal response. However, he showed excellent improvement in BCVA to 6/6 with complete resolution of fluid on SD-OCT after switching to intravitreal Ozurdex implant. This case highlights that an intravitreal dexamethasone implant can be considered as a viable option for the optimal management of PEVAC-like lesions, with good visual acuity outcomes and morphologic response on SD-OCT. Further studies are warranted to gain better insight into the pathogenesis of PEVAC-like lesions and the potential role and mechanism of action of intravitreal dexamethasone implant in its management.

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