This 77YO female has been followed for years with vision of 20/200 OD and counting fingers OS from inactive age-related disciform scars. She then came in with sudden symptomatic vision loss and floaters in her left eye.
Vision was hand motion OS from a breakthrough vitreous hemorrhage from an inferotemporal ectopic choroidal neovascularization (CNV) that grew from the edge of the original macular scar. She was not taking anticoagulants or aspirin.
Following two monthly intravitreal Avastin injections, vision remained at hand motion. The vitreous hemorrhage had cleared, and the subretinal blood was resolving.
Optos imaging shows the original macular scarring, along with varying stages of resolving rub-RPE blood, subretinal blood, and devitalized, yellow subretinal blood.
Learning Points:
Ectopic CNV, also known as peripheral exudative hemorrhagic chorioretinopathy, is an exudative process similar to wet AMD but located in the retinal periphery.
Ectopic CNV can often masquerade as a choroidal mass or uveal melanoma. It can also cause extensive choroidal/suprachoroidal, subretinal, and vitreous hemorrhage, more commonly in patients who are on blood thinners.
The subretinal blood often spontaneously regresses without treatment, although anti-VEGF injections can be used for symptomatic or increasing exudation.
