Different treatment modalities for choroidal neovascularization in two eyes of one patient with bilateral type 2A parafoveal telangiectasia
A 60-year-old man presented with a history of decrease in vision in the left eye (LE) for last 15 days. He was a known diabetic on treatment since past 10 years. On examination, his best corrected visual acuity (BCVA) in the right eye (RE) was 20/30 and that in LE was 20/80. Anterior segment examination was unremarkable except nuclear sclerosis grade 1 in both eyes (BE). Fundus examination RE revealed grayish retina temporal to fovea, about 500 μm wide, with multiple yellowish crystalline deposits and pigments. The left fundus examination showed the presence of subretinal fluid with subretinal hemorrhage measuring about 400 μm in width. A clinical diagnosis of RE type 2A stage 4 IMT and LE type 2A stage 5 IMT was made. The clinical findings were confirmed on optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) []. The patient underwent PDT (greatest linear dimension of 1310 μm, a spot size of 2310 μm) as per the standard protocol.\nAt 1 month of follow-up, LE BCVA was maintained at 20/80 with resolution of subretinal fluid and hemorrhage on fundus examination. FFA showed no signs of activity in the LE. The patient was on regular follow-up with stable findings []. At 4 years of follow-up, he presented with complaints of decrease in vision in RE since the past 4 weeks. The BCVA in the RE was 20/80 and in the LE was 20/40. RE fundus examination revealed the presence of subretinal hemorrhage temporal to the fovea about 300 μm in size and LE scarred membrane. FFA confirmed the activity in RE and scarring in LE []. The patient received two consecutive monthly intravitreal ranibizumab (Lucentis) injections 0.5 mg/0.05 ml in RE. At 1-month follow-up following the second injection, his RE BCVA improved to 20/40 with decrease in retinal thickness on OCT. Improved visual acuity and clinical findings including bilateral macular scar with a vision of 20/40 was maintained till the 6th month follow-up [].