ACTIVATION OF A QUIESCENT CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH DEGENERATIVE MYOPIA.

Introduction: Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. PM may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Case Report: A 66-year-old female came to the Ophthalmology Clinic for a routine ophthalmologic check-up. She mentioned experiencing an ocular trauma in her right eye (RE) during her youth. Measured refraction was RE: - 19.50 Sf, -4.75 cyl 5° while LE: -19.00 Sf, -2.75 cyl 180°. Best corrected visual acuity (BCVA) RE was counting fingers at 30 cm and LE 0.4 with correction. Anterior segment examination revealed RE: stage 5 hypermature cataract while LE: stage 2+ cortico-nuclear cataract. Ocular fundus examination RE: exibited extensive macular atrophy extending close to the temporal vascular arcades, and LE: temporal papillary staphyloma, with a parafoveolar atrophic area. Optical coherence tomography (OCT) showed LE: hyperreflective material in the parafoveolar area, above the pigment epithelium. OCT angiography (OCTA) LE highlighted a hyperreflective material in the central outer retina, consistent with a choroidal neovascular membrane. Given the absence of symptoms and lack of activity in the neovascular membrane, it has been decided to closely monitor the patient. One month later, she reports the onset of metamorphopsia LE (BCVA = 0.2). On OCT section, an increase in retinal thickness is observed, with persistent membrane on OCTA. Therefore, it has been decided to initiate treatment with intraocular injection of aflibercept anti-VEGF 0.05 ml. At the one month follow-up, BCVA improved to 0.4, accompanied by a decrease in retinal thickness observed on OCT. Discussions : The particularity of the case comes from the single functional eye and the absence of symtoms. We chose to reduce the risks for our patient and monitor her closely. Once the first symtoms appeared, prompt treatment with a single intravitreal injection of anti-VEGF therapy was performed. Conclusions: The choice to closely monitor the pacient and start Aflibercept treatment once the onset of metamorphopsia appeard led to the most favourable response: a significant improvement of visual acuity with a visible decrease in retinal thickness OCT. [ABSTRACT FROM AUTHOR]

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