A Brazilian case of exudative perifoveal vascular anomalous complex responsive to aflibercept intravitreal injections

Eur J Ophthalmol. 2024 Mar;34(2):NP68-NP72. doi: 10.1177/11206721231200116. Epub 2023 Sep 6.

Abstract

Purpose: To report a case of exudative perifoveal exudative vascular anomalous complex (ePVAC) in a Brazilian healthy patient that underwent a complete resolution after aflibercept intravitreal injections.

Case description: A 41-year-old healthy Brazilian man complained of acute central vision loss in his right eye (RE). Fundus examination showed a perifoveal hemorrhagic aneurysmal lesion, accompanied by several hard exudates in RE. On fluorescein angiography, these abnormalities showed a progressive hyperfluorescence with surrounding leakage. Optical coherence tomography (OCT) revealed a deep, perifoveal hyporeflective cystic space with a hyperreflective wall and hyperreflective material inside of fibrin-like aspect. Around this aneurism, intraretinal hyporeflective spaces suggestive of exudation were detected. Nor pathological flow signal, or telangiectatic dilations were evidenced on OCT-angiography. Therefore, a diagnosis of exudative ePVAC in RE was hypothesized. After an initial observation, the patient underwent three monthly aflibercept intravitreal injections (0.05 ml/2 mg), with a significative anatomical and functional improvement after two weeks from first dose. On last follow-up at five months from baseline, patient experienced no evidence of new exudation and a stable visual acuity.

Discussion: Placental growth factor (PlGF) may impact on pericytes' dropout, and thus on ePVAC development. In contrast to the other anti-VEGF drugs, aflibercept is the only molecule contrasting PlGF. Therefore, aflibercept would act on ePVAC not as an anti-VEGF drug, but rather as an anti-PlGF one.

Conclusion: This report encouraged the use of aflibercept as a therapeutic option for ePVAC. Further studies are required to confirm our result and the impact of PlGF on ePVAC pathogenesis.

Keywords: age-related macular degeneration < RETINA; anatomy/biochemistry/physiology < RETINA; retina - medical therapies < RETINA; retinal pathology / research < RETINA; retinal telangietasias/macroaneurysms < RETINA.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Angiogenesis Inhibitors / therapeutic use
  • Brazil
  • Female
  • Fluorescein Angiography / methods
  • Humans
  • Intravitreal Injections
  • Male
  • Placenta Growth Factor / therapeutic use
  • Receptors, Vascular Endothelial Growth Factor* / therapeutic use
  • Recombinant Fusion Proteins / therapeutic use
  • Tomography, Optical Coherence / methods
  • Vascular Malformations* / diagnosis
  • Vascular Malformations* / drug therapy

Substances

  • aflibercept
  • Placenta Growth Factor
  • Receptors, Vascular Endothelial Growth Factor
  • Recombinant Fusion Proteins
  • Angiogenesis Inhibitors