Multimodal imaging of bilateral diffuse uveal melanocytic proliferation associated with an iris mass lesion.

BACKGROUND: Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare, paraneoplastic syndrome characterized by bilateral painless visual loss and proliferation of choroidal melanocytes in association with an underlying systemic malignancy. We report a case of bilateral diffuse uveal melanocytic proliferation associated with an underlying gynecological malignancy that also features the infrequent finding of an iris mass lesion, using multimodal imaging including ultra-widefield imaging, spectral domain and swept-source optical coherence tomography. CASE PRESENTATION: A 59-year-old white female with a prior history of gynecological malignancy in remission presented with progressive bilateral visual loss over several weeks. The patient was noted to have a focal iris mass lesion in her right eye. Ultra-widefield color fundus photography showed a characteristic bilateral 'giraffe pattern' of pigmentary changes extending into the periphery as well as multiple discrete deeply pigmented lesions. Ultra-widefield autofluorescence was useful for visualizing the full extent of involvement. Indocyanine green angiography helped to demarcate the discrete pigmented choroidal lesions. Swept-source OCT clearly delineated the alternating zones of retinal pigment epithelium (RPE) thickening and RPE loss, as well as the prominent choroidal infiltration and thickening. CONCLUSIONS: BDUMP is an important diagnosis to consider in the presence of multiple discrete melanocytic choroidal lesions, diffuse choroidal thickening, characteristic RPE changes, iris mass lesions and exudative retinal detachment. Ultra-widefield imaging may demonstrate more extensive lesions than that detected on clinical examination or standard field imaging. Imaging with SS-OCT shows choroidal and RPE characteristics that correlate well with known histopathology of this entity.

Acute Macular Neuroretinopathy Associated With Chikungunya Fever.

A 47-year-old man with recent travel to the Caribbean was admitted with acute febrileillness associated with arthralgia and skin rash followed by sudden onset of bilateral visual field defects. Funduscopy revealed subtle bilateral paracentral dark lesions nasal to the fovea best seen on near infrared imaging as hyporeflective, wedge-shaped, paracentral macular lesions. Spectral-domain optical coherence tomography (SD-OCT) through the lesions revealed hyperreflective bands at the level of the outer plexiform layer and outer nuclear layer (ONL), with concomitant attenuation of the underlying external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). Neither fluorescein angiography nor speckle variance OCT angiography (sv-OCTA) showed any defects in retinal circulation. Work up revealed positive Immunoglobulin M for Chikungunya virus (CHIKV). Six months later, the patient had persistent scotomas, although reduced in size. SD-OCT showed subtle ONL thinning and restoration of the ELM, although EZ and IZ remained disrupted. Chikungunya fever may manifest as bilateral acute macular neuroretinopathy (AMN). Clinicians should be aware of possible systemic associations of AMN. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:596-599.].

LAMELLAR HOLE-ASSOCIATED EPIRETINAL PROLIFERATION: A Clinicopathologic Correlation.

PURPOSE: To correlate clinical and optical coherence tomographic features with histopathological and immunohistochemical findings in an eye undergoing surgical excision of lamellar hole-associated epiretinal proliferation (LHEP). METHODS: An eye with a lamellar macular hole and LHEP without a tractional epiretinal membrane component was identified with spectral-domain optical coherence tomographic imaging and underwent pars plana vitrectomy with LHEP and internal limiting membrane peeling and gas tamponade. The surgically excised LHEP specimen was analyzed with histopathological and immunohistochemical staining using flat-mount preparation techniques. Postsurgical outcomes including visual acuity and optical coherence tomographic imaging were reviewed. RESULTS: With spectral-domain optical coherence tomography, the lamellar macular hole was found to be closed with no residual LHEP after the surgery. Visual acuity improved from 20/200 preoperatively to 20/40 at 6 months after the surgery. Histopathological and immunohistochemical analyses of the LHEP specimen revealed retinal glial cells that reacted positively with anti-glial fibrillary acidic protein and anti-glutamine synthetase, a Müller cell-specific antibody. CONCLUSION: Lamellar macular hole with LHEP may demonstrate closure after pars plana vitrectomy with LHEP and internal limiting membrane peeling and gas tamponade. There was considerable improvement in visual acuity. It is possible that LHEP originates from middle retinal layers of the lamellar hole defect because it contains retinal glial cells, specifically Müller cells.

Intraocular Nematode Affixed to Posterior Lens Capsule.

The clinical presentation of an intraocular nematode unusually affixed to the posterior lens capsule is described. A 64-year-old female patient presented with a 7-year history of gradually declining vision and enlarging central scotoma, but no inflammation. On follow-up 2 years later, vision had further declined and a non-motile, 8-mm nematode was seen affixed to the posterior lens capsule that remained unchanged through final follow-up. The patient disclosed having resided in Africa as a child. Systemic review revealed no evidence of extraocular involvement. Nematode carcasses may remain preserved in the human eye for extended periods without ongoing inflammation.

The Onion Sign in Neovascular Age-Related Macular Degeneration Represents Cholesterol Crystals.

PURPOSE: To investigate the frequency, natural evolution, and histologic correlates of layered, hyperreflective, subretinal pigment epithelium (sub-RPE) lines, known as the onion sign, in neovascular age-related macular degeneration (AMD). DESIGN: Retrospective observational cohort study and experimental laboratory study. PARTICIPANTS: Two hundred thirty eyes of 150 consecutive patients with neovascular AMD and 40 human donor eyes with histopathologic diagnosis of neovascular AMD. METHODS: Spectral-domain optical coherence tomography (SD OCT), near-infrared reflectance (NIR), color fundus images, and medical charts were reviewed. Donor eyes underwent multimodal ex vivo imaging, including SD OCT, before processing for high-resolution histologic analysis. MAIN OUTCOME MEASURES: Presence of layered, hyperreflective sub-RPE lines, qualitative analysis of their change in appearance over time with SD OCT, histologic correlates of these lines, and associated findings within surrounding tissues. RESULTS: Sixteen of 230 eyes of patients (7.0%) and 2 of 40 donor eyes (5.0%) with neovascular AMD had layered, hyperreflective sub-RPE lines on SD OCT imaging. These appeared as refractile, yellow-gray exudates on color imaging and as hyperreflective lesions on NIR. In all 16 patient eyes, the onion sign persisted in follow-up for up to 5 years, with fluctuations in the abundance of lines and association with intraretinal hyperreflective foci. Patients with the onion sign disproportionately were taking cholesterol-lowering medications (P=0.025). Histologic analysis of 2 donor eyes revealed that the hyperreflective lines correlated with clefts created by extraction of cholesterol crystals during tissue processing. The fluid surrounding the crystals contained lipid, yet was distinct from oily drusen. Intraretinal hyperreflective foci correlated with intraretinal RPE and lipid-filled cells of probable monocytic origin. CONCLUSIONS: Persistent and dynamic, the onion sign represents sub-RPE cholesterol crystal precipitation in an aqueous environment. The frequency of the onion sign in neovascular AMD in a referral practice and a pathology archive is 5% to 7%. Associations include use of cholesterol-lowering medication and intraretinal hyperreflective foci attributable to RPE cells and lipid-filled cells of monocyte origin.

ASSOCIATION OF PREVASCULAR VITREOUS FISSURES AND CISTERNS WITH VITREOUS DEGENERATION AS ASSESSED BY SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To demonstrate the presence of prevascular vitreous fissures (PVF) and posterior vitreous cisterns in vivo and correlate with the degree of vitreous degeneration (VD). METHODS: This was a cross-sectional study using Topcon Deep Range Imaging OCT-1 Atlantis 3D swept source optical coherence tomography for acquiring scans of posterior vitreous covering an 18 × 18-mm area in 104 eyes of 52 healthy volunteers without posterior vitreous detachment. RESULTS: We observed that increasing age was associated with higher VD grades (P < 0.05). Prevascular vitreous fissures, characterized by areas of lower optical density overlying the retinal blood vessels, were identified in 93 (89%) eyes, and the presence of PVF correlated with lower VD grades (P < 0.05). Presence of cisterns correlated with higher VD grades (P < 0.05). All eyes with absence of PVF were found to have established cisterns. Prevascular vitreous fissures were connected with cisterns in 44 of the 71 (62%) eyes with cisterns, while the base of the cistern was directly above retinal blood vessels in 38 (54%) eyes, which suggests that the cisterns could be derived from PVF. CONCLUSION: Swept source optical coherence tomography imaging can identify PVF and cisterns occurring in the context of age-related VD, and PVF appeared to be possible precursors of cisterns.

ASSOCIATION BETWEEN NEEDLE SIZE, POSTINJECTION REFLUX, AND INTRAOCULAR PRESSURE SPIKES AFTER INTRAVITREAL INJECTIONS.

PURPOSE: To compare the effect of 30-gauge versus 32-gauge needle size on postinjection reflux and immediate postinjection intraocular pressure (IOP(immed_post)) spikes in eyes injected with anti-vascular endothelial growth factor agents. METHODS: This was a prospective interventional case series of 65 eyes of 54 consecutive patients in a clinical practice setting who received intravitreal anti-vascular endothelial growth factor therapy. All eyes had preinjection IOP, IOP(immed_post), postinjection reflux, and axial lengths recorded. RESULTS: There was a higher incidence of postinjection reflux in eyes injected with 30-gauge (53%) compared with those injected with 32-gauge (13%, P = 0.0007). Among 34 eyes injected with 30-gauge, 16 eyes without appreciable postinjection reflux had mean IOP(immed_post) of 44.3 ± 7.48 mmHg and mean IOP(immed_post) elevation of 29.6 ± 2.10 mmHg, which was significantly higher than the 18 eyes with reflux (mean IOP(immed_post) of 18.8 ± 7.15 mmHg and mean IOP(immed_post) elevation of 4.5 ± 1.74 mmHg, P < 0.0001). Among 31 eyes injected with 32-gauge, 27 eyes without appreciable postinjection reflux had mean IOP(immed_post) of 44.4 ± 10.82 mmHg and mean IOP(immed_post) elevation of 29.5 ± 1.99 mmHg, which was significantly higher than the 4 eyes with reflux (mean IOP(immed_post) of 21.3 ± 8.54 mmHg and mean IOP(immed_post) elevation of 9.5 ± 4.05 mmHg, P < 0.001). The differences in reflux and IOP between the two groups were unrelated to axial lengths (P = 0.451). CONCLUSION: Eyes receiving injections with 32-gauge needles had a lower incidence of postinjection reflux and higher mean IOP immediately after injection.

New insights into Stargardt disease with multimodal imaging.

A 20-year-old woman with bilateral mild blurring of vision presented with a bull's eye maculopathy and was diagnosed with Stargardt disease, confirmed with genetic testing. The authors present several novel multimodal imaging findings including multicolor and multi-spectral imaging that enhanced visualization of perifoveal flecks, fundus autofluorescence that revealed both perifoveal and perimacular rings of hyperautofluorescence, adaptive optics imaging that revealed unprecedented visualization of cones at the fovea due to decreased cone density, and spectral-domain optical coherence tomography that identified thickening and increased hyperreflectivity of the external limiting membrane as a possible transient biomarker of early Stargardt disease.

Swept-source optical coherence tomography features of choroidal nevi.

PURPOSE: To investigate the morphologic characteristics of choroidal nevi using swept-source optical coherence tomography and compare this with enhanced-depth optical coherence tomography. DESIGN: Retrospective observational case series. METHODS: One choroidal nevus each from 30 eyes of 30 patients was included and received imaging with swept-source OCT (SS-OCT) and enhanced-depth imaging OCT (EDI-OCT). For SS-OCT, a scan acquisition protocol was used involving 12 mm horizontal and vertical scans in the posterior fundus. The main outcome measures were morphologic features of choroidal nevi obtained with SS-OCT imaging. These features were compared to images obtained with EDI-OCT. A 2-tailed Fisher exact test was the statistical method used. RESULTS: SS-OCT allowed for an appreciation of intralesional details: Of the 30 nevi imaged, intralesional vessels were apparent in 30 (100%), intralesional cavities in 6 (20%), intralesional granularity in 14 (47%), abnormal choriocapillaris in 25 (83%), and abnormal choriocapillaris confined to the tumor apex in 17 (58%). Distended bordering vessels were identified in 22 nevi (73%) and were significantly associated with the presence of previous or persistent subretinal fluid. Intrinsic hyperreflectivity with hyporeflective shadowing was significantly (P = .05) more apparent in 14 of 21 melanotic nevi (67%) compared with 2 of 9 amelanotic nevi (22%). Visualization of the complete nevus-scleral interface was significantly (P = .02) more apparent in 7 of 9 amelanotic nevi (78%) compared with 6 of 21 melanotic nevi (29%), and was not significantly related to tumor thickness (measured by ultrasound) or to tumor configuration. Tumor diameter (but not tumor height) was statistically significantly associated with secondary retinal changes (P = .05) and configuration (P = .01). EDI-OCT was equivalent at determining secondary retinal changes (P = .29), the presence of distended bordering vessels (P = 1), visualization of the nevus-scleral interface (P = .6), and hyporeflective gradation at the nevus-scleral interface (P = .33). However, in melanotic lesions, SS-OCT was significantly superior at visualizing intralesional vessels (P = .0002), intralesional granularity (P = .0005), and abnormal choriocapillaris (P = .0001). CONCLUSION: Imaging of choroidal nevi with SS-OCT enables visualization of intralesional details such as vessels (present in 100% of tumors imaged), cavities, and granularity. For melanotic lesions, SS-OCT is significantly better at depicting certain intralesional characteristics compared to EDI-OCT. Distended bordering vessels were recognized in over two thirds of the nevi imaged and were significantly associated with previous or persistent subretinal fluid.

Pachychoroid neovasculopathy.

PURPOSE: To report 3 cases of pachychoroid neovasculopathy, a form of Type 1 (sub-retinal pigment epithelium) neovascularization, occurring over areas of increased choroidal thickness and dilated choroidal vessels. METHODS: A retrospective observational case series of three patients who underwent comprehensive ophthalmic examination and multimodal imaging with fundus photography, fundus autofluorescence, spectral domain optical coherence tomography, enhanced depth imaging optical coherence tomography, fluorescein angiography, and indocyanine green angiography. RESULTS: In all 3 eyes of 3 patients, aged 55 years to 63 years, there was Type 1 neovascularization overlying a localized area of choroidal thickening and dilated choroidal vessels seen with enhanced depth imaging optical coherence tomography. With indocyanine green angiography, there were large choroidal veins and choroidal hyperpermeability seen beneath the area of the neovascular tissue in all three eyes. No eyes had evidence of submacular exudative detachment or autofluorescence changes to suggest antecedent acute or chronic central serous chorioretinopathy. No eyes had drusen or degenerative changes to suggest age-related macular degeneration or other degenerative diseases. In one patient, the fellow unaffected eye demonstrated retinal pigment epithelium abnormalities, best seen with fundus autofluorescence, overlying focal dilated choroidal vessels seen with enhanced depth imaging optical coherence tomography and associated choroidal hyperpermeability seen with indocyanine green angiography, consistent with the diagnosis of pachychoroid pigment epitheliopathy. All three eyes showed the appearance of polypoidal structures within the neovascular tissue. CONCLUSION: Pachychoroid neovasculopathy falls within a spectrum of diseases associated with choroidal thickening that includes pachychoroid pigment epitheliopathy, central serous chorioretinopathy, and polypoidal choroidal vasculopathy and should be considered as a possible diagnosis in eyes with features of Type 1 neovascularization and choroidal thickening in the absence of characteristic age-related macular degeneration or degenerative changes. Pachychoroid neovasculopathy may occur as a focal abnormality within the macula, even in myopic eyes with normal subfoveal choroidal thickness. Pachychoroid neovasculopathy can ultimately progress to the development of polypoidal choroidal vasculopathy.

Feasibility and clinical utility of ultra-widefield indocyanine green angiography.

PURPOSE: To evaluate the feasibility and clinical utility of a novel noncontact scanning laser ophthalmoscope-based ultra-widefield indocyanine green angiographic system. METHODS: Ultra-widefield indocyanine green angiographic images were captured using a modified Optos P200Tx that produced high-resolution images of the choroidal vasculature with up to a 200° field. Ultra-widefield indocyanine green angiography was performed on patients with a variety of retinal conditions to assess utility of this imaging technique for diagnostic purposes and disease treatment monitoring. RESULTS: Ultra-widefield indocyanine green angiography was performed on 138 eyes of 69 patients. Mean age was 58 ± 16.9 years (range, 24-85 years). The most common ocular pathologies imaged included central serous chorioretinopathy (24 eyes), uveitis (various subtypes, 16 eyes), age-related macular degeneration (12 eyes), and polypoidal choroidal vasculopathy (4 eyes). In all eyes evaluated with ultra-widefield indocyanine green angiography, high-resolution images of choroidal and retinal circulation were obtained with sufficient detail out to 200° of the fundus. CONCLUSION: In this series of 138 eyes, scanning laser ophthalmoscope-based ultra-widefield indocyanine green angiography was clinically practical and provided detailed images of both the central and peripheral choroidal circulation. Future studies are needed to refine the clinical value of this imaging modality and the significance of peripheral choroidal vascular changes in the diagnosis, monitoring, and treatment of ocular diseases.

The spectrum of superficial and deep capillary ischemia in retinal artery occlusion.

PURPOSE: To describe the spectrum of retinal capillary ischemia, including superficial and deep capillary ischemia, as identified with spectral-domain optical coherence tomography (SD OCT), that occurs in retinal arterial occlusive disease. DESIGN: Retrospective observational case series. METHODS: Clinical charts, color fundus photography, red-free fundus photography, fluorescein angiography, near-infrared reflectance, and SD OCT imaging in 40 eyes of 35 patients with retinal arterial occlusive disease were studied in both the acute and chronic phases in multicenter clinical practices. SD OCT imaging analysis was employed to characterize the presence of superficial and deep capillary ischemia in each eye. RESULTS: Of the 40 eyes, 15 eyes had central retinal artery occlusion (CRAO), 22 eyes had branch retinal artery occlusion (BRAO), and 3 eyes had cilioretinal artery occlusion. During the acute phase, SD OCT showed the following 3 distinct patterns, related to retinal ischemia occurring at varying levels within the retina: (1) thickening and hyperreflectivity of the inner retinal layers, including the nerve fiber and ganglion cell layers owing to ischemia of the superficial capillary plexus; (2) a hyperreflective band at the level of the inner nuclear layer, termed "paracentral acute middle maculopathy," representing ischemia of the intermediate and deep retinal capillary plexuses (deep capillary ischemia); and (3) diffuse thickening and hyperreflectivity of both the inner and middle retinal layers, which represented both superficial and deep capillary ischemia. Of all eyes, 31 (78%) had both superficial and deep lesions. The remaining 9 eyes (22%) had isolated deep capillary ischemia producing paracentral acute middle maculopathy with sparing of the superficial capillary plexus and a normal fluorescein angiographic appearance. As the lesions evolved into the chronic phase over the ensuing 3 months, the resultant thinning and atrophy reflected the retinal layers affected during the acute phase. CONCLUSION: SD OCT imaging reveals the spectrum of capillary ischemia in retinal artery occlusive disease showing variable involvement of the superficial and intermediate/deep capillary plexuses. Isolated deep capillary ischemia manifested as paracentral acute middle maculopathy on SD OCT and may be seen in some eyes with retinal arterial circulation compromise despite complete absence of perfusion abnormalities on fluorescein angiography.

Extreme choroidal thinning in high myopia.

PURPOSE: To describe the spectral domain optical coherence tomography characteristics of extreme choroidal thinning in high myopia and demonstrate its compatibility with good visual acuity. METHODS: This was a retrospective observational case review of nonconsecutive myopic patients with extreme choroidal thinning, defined as a subfoveal choroidal thickness of 20 µm or less as measured with spectral domain optical coherence tomography. Clinical features, such as visual acuity, axial length, and spectral domain optical coherence tomography characteristics including choroidal and retinal thicknesses in four quadrants were analyzed. RESULTS: Thirty-six eyes of 20 patients with extreme choroidal thinning were included. Mean subfoveal choroidal thickness was 13.9 ± 6.0 µm, mean age was 71 years (range, 32-85 years), mean axial length was 30.7 ± 2.2 mm, and mean follow-up duration was 44.7 ± 15.4 months. Of these, 25 eyes (70%) had visual acuity of 20/40 or better (mean visual acuity was 20/30), whereas the remaining eyes had mean visual acuity of 20/193. All eyes with extreme choroidal thinning had prominent choroidal vessels seen under the macula documented on color fundus photography and near-infrared reflectance imaging. All eyes with visual acuity poorer than 20/40 had fovea-involving choroidal neovascularization and/or atrophy. In the 25 eyes with good visual acuity, the mean choroidal thickness was thinnest at the nasal zone, followed by inferior, superior, and temporal zones (P = 0.01); and there was no detectable decrease in choroidal thickness over time. The mean retinal thickness was thinner in the fovea and parafoveal zones when compared with highly myopic eyes without extreme choroidal thinning. CONCLUSION: Extreme choroidal thinning in myopic eyes is compatible with good visual acuity of 20/40 or better, may be present in a wide age range, and may not demonstrate any progressive decline over up to 70 months of follow-up; suggesting that choroidal thickness alone is not a reliable indicator of visual function.

Comparing functional and morphologic characteristics of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation.

PURPOSE: To compare the functional and morphologic characteristics and evolution of lamellar macular holes (LMHs) with and without lamellar hole-associated epiretinal proliferation (LHEP). METHODS: This was a retrospective observational case review of 145 eyes of 136 patients with LMH seen in a vitreoretinal clinical practice, and the eyes were subdivided into 2 groups based on the presence or absence of LHEP. Main outcome measures were logarithm of minimal angle of resolution (logMAR) visual acuity and morphologic characteristics as seen with spectral domain optical coherence tomography over retrospective follow-up. RESULTS: In 62 eyes (42.7%), LHEP was detected, while 83 eyes (57.3%) had the presence of epiretinal membrane without LHEP. The mean logMAR visual acuity in eyes with LHEP was 0.51 (20/65 Snellen equivalent), which was significantly poorer than that in the eyes without LHEP at 0.33 (20/43 Snellen equivalent, P = 0.002). Multivariate analysis showed that the presence of LHEP was significantly associated with larger LMH diameter at the middle retinal level (P = 0.01) and thinner retinal thickness at the base of the LMH (P < 0.001). A higher proportion of eyes with LHEP (88%) had ellipsoid disruption compared with eyes without LHEP (24%, P = 0.001). Over the mean retrospective follow-up of 26 months, 5% of eyes with LHEP had functional decline of 0.3 logMAR visual acuity compared with 4% of eyes without LHEP (P = 0.99), whereas 18% of eyes with LHEP had morphologic progression compared with 13% of eyes without LHEP (P = 0.49). CONCLUSION: Eyes with LMH and LHEP were associated with poorer visual acuity, larger LMH diameters, thinner retinal thickness, and higher incidence of ellipsoid disruption compared with eyes without LHEP, suggesting a process involving more severe retinal tissue loss and injury. Both LMH with and without LHEP seemed to be stable configurations over time.

Adaptive optics imaging of cone mosaic abnormalities in acute macular neuroretinopathy.

BACKGROUND AND OBJECTIVE: To assess the cone photoreceptor mosaic in acute macular neuroretinopathy (AMN) using adaptive optics (AO) imaging. PATIENTS AND METHODS: Four patients with AMN were evaluated retrospectively by near-infrared reflectance (IR) confocal scanning laser ophthalmoscopy (SLO), spectral-domain optical coherence tomography (SD-OCT), and a flood-illuminated retinal AO camera. Microperimetry was performed in one patient. RESULTS: The cone photoreceptor density was decreased at the level of the AMN lesions. The cone mosaic disruption appeared heterogeneous and more widespread than the lesion detected in the IR-SLO and SD-OCT images. The areas of cone loss correlated with SD-OCT and microperimetry. After resolution of the AMN lesion on IR-SLO, there was incomplete recovery of the cone photoreceptor mosaic. CONCLUSION: Cone photoreceptor damage and reconstitution were documented in vivo at the cellular level in AMN using AO imaging. AO imaging appeared more sensitive than combined IR-SLO and SD-OCT to detect and follow photoreceptor damage in patients with AMN.

Intravitreal polypoidal choroidal vasculopathy in radiation retinopathy.

A 30-year-old woman diagnosed with choroidal melanoma and treated with plaque radiation and transpupillary thermotherapy 5 years earlier presented with recalcitrant proliferative radiation retinopathy despite multiple intravitreal anti-vascular endothelial growth factor injections. Swept-source and spectral-domain optical coherence tomography (OCT) demonstrated intravitreal polyps lying on the surface of atrophied chorioretinal tissue. Fluorescein angiography (FA) revealed leakage from these saccular choroidal neovasculopathic vessels adjacent to a large zone of poor choroidal perfusion. Intravitreal polypoidal choroidal vasculopathy may be associated with radiation retinopathy and is well-demonstrated with swept-source and spectral-domain OCT and FA.