Figure 4.

Case 19. An 80-year-old man treated with ranibizumab for recurrent exudation from a branching vascular network. (a–d) The BCVA is 0.3 decimal VA in the right eye with PCV at the initial treatment. (a) A red-free photograph shows 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, 6300 μm). (e–h) Six months after the initial PDT with two applications of PDT, the BCVA remains 0.3 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) Twenty-five months after the initial PDT, the BCVA decreased from 0.3 to 0.15 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 intravitreal injections of ranibizumab (IVR) were administered. (m–p) Three months after baseline, the BCVA remains stable. (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 is needed. (q–t) At month 14, six IVR injections were administered. The BCVA improved from 0.15 to 0.2 decimal VA. (r) FA shows leakage at the macular area. (s, t) ICGA shows recurrent polypoidal lesions with the SRD on OCT. An additional treatment of combined therapy of IVR and PDT was performed. (u, v) At month 24, seven IVR injections and one combined treatment of IVR and PDT were administered. The BCVA improved from 0.15 to 0.6 decimal VA. A horizontal OCT image shows no exudation.