A Case Report of Acute Visual Acuity Decrease due to Choroidal Nonperfusion After Photodynamic Therapy

ABSTRACT

PURPOSE: We report a case of visual recovery in 11 weeks after acute, severe visual acuity decrease without significant fundus change following photodynamic therapy (PDT) for occult choroidal neovascularization (CNV) related to age-related macular degeneration. METHODS: A 79-year-old female patient visited our clinic because of decreased vision which had developed 1 week previously in her left eye. Best corrected visual acuity was 0.4 in the left eye. On fundus examination, there were multiple drusen around the fovea, hyperpigmentation and irregular elevation of retinal pigment epithelium, and serous pigment epithelium detachment on the macula. Fluorescein angiogram showed stippled hyperfluorescence with indistinct border in the early phase and hyperfluorescence due to the leakage from CNV of diffuse type ooze in the late phase. ICG angiogram showed focal hyperfluorescence in the mid and late phases. PDT with verteporfin was performed for regression of CNV. The day after PDT, visual acuity decreased to counting fingers at 20 cm and on fundus examination, there was no increase of serous pigment epithelium detachment or subretinal hemorrhage, but only mild retinal edema in the inferonasal area to the fovea. Fluorescein angiogram and ICG angiogram showed only round-shaped hypofluorescence due to choroidal nonperfusion localized to the PDT site. Eleven weeks after PDT, choroidal circulation returned to normal and visual acuity was 0.6. RESULTS: Acute, severe visual acuity decrease after PDT can be developed by choroidal nonperfusion and can be recovered with the improvement of choroidal perfusion.