Long-term follow-up and treatment of lamellar hole-associated epiretinal proliferation presenting with exudative perivascular anomalous complex

TL;DR

A 74-year-old woman with a rare eye condition showed better results with dexamethasone implants than anti-VEGF injections over a four-year treatment period.

Contribution

Demonstrates the superior efficacy of dexamethasone intravitreal implants over anti-VEGF therapy for lamellar hole-associated epiretinal proliferation.

Findings

Dexamethasone intravitreal implant led to anatomical improvement and reduction of ePVAC lesions.

Anti-VEGF therapy had limited effectiveness with treatment intervals exceeding 12 weeks.

Cataract progression later caused a decline in visual acuity despite treatment success.

Abstract

To report a patient with lamellar hole-associated epiretinal proliferation (LHEP), presenting with exudative perifoveal vascular anomalous complex (ePVAC), who was initially treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF), aflibercept 2 mg followed by dexamethasone intravitreal implant 0.7 mg.

A complete ophthalmologic examination was performed on a 74-year-old woman who was referred for unilateral blurred vision. The patient was in good general health with no history of diabetes, hypertension, or blood dyscrasias and was followed up with swept source optical coherence tomography (SS-OCT). The patient was followed from September 2019 to March 2024.

Multimodal imaging of the left eye showed epiretinal proliferation (ERP) with lamellar hole (LM) formation associated with perifoveal isolated large aneurysmal change, accompanied by small hemorrhage, intraretinal exudation and small hard exudate accumulations.

The patient received three monthly intravitreal injections as a loading dose (LD), followed by treat and extend regimen. Four weeks post LD the mean central retinal thickness (CMT) decreased from 467 to 288 μm, LHEP cystoid spaces were reduced, and best corrected visual acuity (BCVA) improved from 20/120 to 20/60. Treatment continued with extended intervals. After 11 injections there was a follow-up loss at 18 weeks with deterioration of BCVA.

After a total of 18 aflibercept injections it was decided to switch to dexamethasone intravitreal implant. At three months there was anatomical improvement and the ePVAC lesions almost disappeared. At 14 weeks after the second implant, OCT confirmed further anatomical improvement and involution of the PVAC lesions. At 10 weeks after the third dexamethasone intravitreal implant there was a deterioration due to the progression of cataract and BCVA had dropped to 20/120. The intraocular pressure was between normal limits during the follow-up period.

Anti-VEGF therapy is less effective than dexamethasone intravitreal implant with a treatment interval greater than 12 weeks.

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