This 71YO male had a vitrectomy in 2018 for a breakthrough vitreous hemorrhage from ectopic choroidal neovascularization (CNV). He did well with 20/40 vision until a recurrent vitreous hemorrhage developed two years later.
The vitreous cleared with several monthly intravitreal Avastin injections, but vision remains at hand motion due to submacular blood, some of which is yellow and devitalized. We discussed repeat vitrectomy with subretinal TPA, but he elected for in-office anti-VEGF injections. He is not on any systemic blood thinners.
Learning Points:
Ectopic CNV, also known as peripheral exudative hemorrhagic chorioretinopathy, is a degenerative and 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 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.
