Título / Title

EVOLUTION OF TYPE 2 NEOVASCULARIZATION WITH PITCHFORK'S SIGN AFTER LOADING DOSE OF AFLIBERCEPT - CASE REPORT

Introdução / Purpose

To report the case of a patient with type 2 neovascularization, whose treatment with a loading dose of Aflibercept had great results in the recovery of visual acuity.

Material e Método / Methods

Interventional case report

Resultados / Results

Male patient, 57 years old, without comorbidities, admitted with a complaint of low visual acuity (VA) in the right eye (OD) for about 1 month. At ophthalmologic examination, OD presented best visual acuity (BCVA) 20/150, retinal mapping showed a stained optic disc with papillary excavation 0.4, arteriolar attenuation with increased dorsal reflex arteriolar, subretinal and intraretinal hemorrhage in the macula with retinal thickening, and hypochromic lesions in macular region, without predisposing degenerations in the periphery. Optical coherence tomography (OCT) of the OD macula had material hyperreflective subretinal (SHRM) with spiked hyperreflective lesions (pitchfork sign) in projection on the external retina and subretinal fluid in the foveal and nasal parafoveal regions. Optical coherence tomography with angiography (OCTA) demonstrated neovascularization in the slab of the external retina with decorrelation signal; fluorescein angiography (FGA) showed hyperfluorescence due to leakage (classic NVM). The patient underwent a loading dose of intravitreal injection (IVI) of antiangiogenic (Aflibercept). After this, the patient presented BVCA of 20/20, being evidenced in the OD retinography and redfree regression of the hemorrhage and alteration of the pigmentation in the macular region. OCT showed the presence of pigment epithelial detachments (PED) at the location of the Pitchfork sign, in addition to SHRM involution and absence of subretinal fluid. OCTA showed involution of neovascular formation in the outer retinal slab

Discussão e Conclusões / Conclusion

This case report showed that intravitreal injection of anti-VEGF can be a valuable therapeutic option to restore visual acuity in eyes with neovascularization secondary to punctate inner choroidopathy (PIC).

Palavras Chave

Pitchfork signs, Type 2 neovascularization, Aflibercept

Area

CLINICAL RETINA