Multimodal imaging of Perifoveal Exudative Vascular Anomalous Complex (PEVAC)

Francesco Barca Lorenzo De Angelis Dario Giorgio Benedetta Pieri Veronica Donati

Multimodal imaging showing PEVAC in the LE of a 73-year-old woman. The patient did not exhibit any clinical signs of diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusion, or myopic degenerative retinal disease. (A) Ultra-wide field fundus imaging showing perifoveal isolated aneurismal lesions ( magnified imaging in the bottom)  barely visible on color photography. Drusenoid lesions are detectable in the mid-periphery. (B,C) Fluorescein angiography (FA) reveals  well-defined hyperfluorescent lesions well detectable in the (B) early phase  with leakage in the (C) late frame. (D) These lesions appear as hyporeflective spots on IR imaging. (E) An increase of the autofluorescence signal is detectable on B-FAF at the macula. (F) Structural OCT examination passing through the lesions showing the presence of an isolated, well-defined perifoveal aneurysmal lesions with a hyperreflective wall (red and yellow arrowhead) and surrounding intraretinal cystic spaces. (G) OCT-angiography confirming the presence of perifoveal capillary abnormalities (green line) in the superficial  (red arrow ) and deep capillary plexus (yellow arrow) and a mild rarefaction of retinal capillaries in the perilesional area in both the plexi. No abnormalities are detectable in the avascular slab. More specifically, corresponding B-scans with flow overlay clearly disclose an isolated large dilation (red and yellow arrows) corresponding to PEVAC with detectable flow inside the lesions

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