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Fig. 1.

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Fig. 1. A 76-year-old man with a medical history of hypertension was receiving vascular endothelial growth factor (VEGF) agents regularly for neovascular age-related macular degeneration (nAMD) with polypoidal choroidal vasculopathy (PCV) of the left eye (A). Ultra-widefield fundus photography (UWFP) (optomap; Optos, Dunfermline, UK) obtained before the switch to brolucizumab shows an orange polypoidal lesion superior to the macula (yellow box). No cotton wool spots or signs of vasculitis are present (red and green boxes). (B) The optical coherence tomography (OCT) exam (Cirrus HD-OCT 5000; Carl Zeiss Meditech, Berlin, Germany) performed before the medication switch shows mild intraretinal fluid (IRF) (green arrows) and persistent pigment epithelial detachment (PED) with a hyper-reflective region posterior to the PED (red arrows). (C) The OCT angiography (OCTA) exam (Cirrus HD-OCT 5000; Carl Zeiss Meditech) reveals active vessels at the hyper-reflective region posterior to the PED (red arrows), which are indicative of type 1 choroidal neovascularization (CNV). (D) UWFP obtained 4 weeks after the first brolucizumab injection shows no evidence of intraocular inflammation (IOI). (E) OCT indicates the decreased size of the PED (yellow arrows) and resolution of the IRF. The hyper-reflective area of the PED (red arrows) appears well demarcated. (F) On OCTA, no regression of CNV is observed; however, the haziness around the CNV appears to have decreased (red arrows), which is suggestive of decreased CNV activity. (G) UWFP obtained 8 weeks after the first brolucizumab injection shows cotton wool spots on the superior and inferior arcades (white arrows). (H) OCT depicts the increased sizes of the PED and IRF (green arrows). CNV was noted at superior to fovea (red arrows). (I) OCTA shows increased vascularity of the PED and haziness (red arrows). (J) Fluorescein angiography (FA) displays moderate disc leakage (yellow arrow) and peripheral capillary vessel leakage (white arrows). Reactivation of the CNV is indicated by leakage and late staining at the previous CNV site (red arrows). (K) Upon slit-lamp examination, anterior chamber cell grade 0.5 + and flare grade 0 with endothelial dusting (yellow arrows) are noted. (L) UWFP shows resolution of the cotton wool spots (red and green boxes) after one week of topical corticosteroids and oral prednisolone. (M) Upon slit-lamp exam, the anterior chamber was clear, and the endothelial dusting had resolved.
J Retin 2022;7:59-64 https://doi.org/10.21561/jor.2022.7.1.59
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