A 46-year-old male presented with diminution of vision in the left eye since 2 months. Patient had a history of vitreo-retinal surgery for rhegmatogenous retinal detachment in the left eye. Postoperative best-corrected visual acuity (BCVA) recorded was 3/60, N36.
At presentation BCVA was 6/6, N6 in the right eye and 2/60, N36 in the left eye. Slitlamp examination was unremarkable in both eyes. Fundus was unremarkable in the right eye. The left eye showed pathologic myopia (PM) with peripapillary chorioretinal atrophy. A Fuchs spot and adjacent large choroidal vessels were seen in an area of macular atrophy [Fig. 1a]. SS-OCT-A of the choroidal vasculature confirmed the presence of large choroidal vessels with a vortex ampulla configuration [Fig. 1b]. The structural SS-OCT through this area showed a clear connection between the choroid and an intra-scleral vessel below the subfoveal scar [Fig. 1c].
Figure 1.
The left eye fundus photo detail (Optos Daytona, Dunfermline Scotland, UK) showing PM with macular atrophy and large choroidal vessels abutting a Fuchs spot (a). The OCT-Angiography (PLEX Elite 9000, Carl Zeiss Meditec, Jena, Germany) 3 × 3 mm choroidal-slab (localized in white box in a) shows the corresponding venous vortex ampulla (b). Structural SS-OCT (Swept Source DRI OCT-1 Atlantis, Topcon, Tokio, Japan) shows a clear connection between the choroid and a large intra-scleral vessel under the subretinal CNVM, illustrating the co-localization of the CNVM and the macular vortex vein (yellow star in b and c)
Myopic CNVM in PM are characterized by an active, scar, and atrophic phase.[1] A correlation between the CNVM location and the scleral penetration site of the short posterior ciliary arteries has been reported.[2] In addition, posterior routes of venous choroidal outflow can be found in about one quarter of high myopic eyes at the margin of the optic nerve head or as macular vortex veins. The prevalence of a Fuchs spot is higher in these eyes. It has been postulated that choroidal circulatory disturbances in eyes with posterior venous drainage routes, may play a role in the development of Fuchs spot.[3]
In our case the macular vortex vein that exits the sclera subfoveally appears to be the direct venous drainage site of the choroid below the CNVM. In the presence of thin choroid in PM, development of CNVM questions the origin and viability of the CNVM. The presence of an extrascleral vascular connection to the choroid, may explain the survival of the CNVM.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
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References
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