FP1867 : Perifoveal exudative vascular anomalous complex(PEVAC)- newer associations with imaging findings

Dr.Apoorva A G, A15802

A 71 year old male presented with DOV in left eye since 6 months. No systemic illnesses. BCVA OD- 6/6, OS- 6/60. Anterior segment was unremarkable. Fundus examination showed left eye having peripapillary staphyloma, prepapillary arterial loops, right angled bend of arterioles temporal to macula dipping into an aneurysmal dilation about 1 DD temporal to fovea with hard exudates. OCT showed a hyperreflective structure in inner retina with backshadowing with cystoid spaces. OCTA showed flow in SVC and perilesional capillary loss in DVC. Diagnosis of PEVAC was made. Thermal laser done. At 2 months lesion reduced in size and no flow was seen in SVC on OCTA. Arterial loops with arterioarterial anastomosis and PEVAC-like ectasia have not been described previously. We hypothesize that a PEVAC like ectasia is a sequelae of a slow flow retinopathy caused by arterial loops which explains their resistance to anti VEGF therapy. Thermal laser is a viable treatment for this condition.