Figure 3.

Case 17. A 69-year-old man treated with ranibizumab for recurrent exudation from branching vascular networks. (a–d) At the initial treatment, the BCVA is 0.4 decimal VA in the right eye with PCV. (a) A red-free photograph shows lipid and a SRD at the macular area. (b) FA shows occult CNV. (c) ICGA clearly shows polypoidal lesions and a branching vascular network. (d) A horizontal OCT image shows a SRD and anterior protrusion of a highly reflective layer corresponding to the polypoidal lesions. ICGA-guided PDT was applied as the initial treatment (laser spot size, 4900 μm). (e–h) Three months after the initial PDT, the BCVA remains 0.4 decimal VA. (g) ICGA shows complete regression of the polypoidal lesions. (h) A horizontal OCT image shows that the SRD has resolved. No additional treatment is needed. (i–l) Eighteen months after the initial PDT, the BCVA decreased from 0.4 to 0.3 decimal VA. (j) FA shows recurrent leakage at the macular area. (k) ICGA shows a branching vascular network and complete regression of the polypoidal lesions. (l) A horizontal OCT image shows recurrence of the SRD. This period was defined as baseline. Three consecutive monthly IVR injections were performed. (m–p) Three months after baseline, the BCVA improved from 0.3 to 0.5 decimal VA. (n) FA shows no leakage at the macular area. (p) A horizontal OCT image shows that the SRD has decreased in size. No additional treatment was performed. (q, r) Eight IVR injections were administered over 12 months. The BCVA improved from 0.3 to 0.5 decimal VA with a smaller SRD on OCT. No additional treatment is needed. (s–v) At month 24, the BCVA improved from 0.3 to 0.6 decimal VA. (t) FA shows recurrent leakage at the macular area. (u) ICGA shows a branching vascular network and no polypoidal lesions. (v) The twelfth IVR injection was administered.