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A 71-year-old woman came to our clinic complaining about decreased vision, blurry vision and metamorphopsia in LE.
She reported systemic hypertension, hypothyroidism, denied eye’s pathologies and had never undergone eye’s surgical treatments. At baseline visit (T0) BCVA (RE) was 20/25 Snellen, BCVA (LE) was 20/50 Snellen, OOAS was normal and OOT was 18 mmHg (NCT). We performed multimodal imaging that showed in the left eye a dome-shaped area referable to subretinal fluid, pigmentary alterations of the EPR and focal hemorrhages (fig.1) that appeared hypoautofluorescent due to the BAF shielding effect (fig.2). Tomographic examination (OCT Heidelberg Spectralis – Fig.3) showed the presence of pachychoroid (431 μm), subretinal fluid, hyperreflective subretinal material (SHRM) and an elevation of EPR in the extrafoveal supero-nasal sector which showed signs of vascular flow posing the suspicion of a polypoidal lesion at the OCT-A exam (fig.4). The fluorangiographic exam (fig.5) showed early focal hyperfluorescence with surrounding hypofluorescent area due to masking effect (hemorrhage) with leakage in late phases, while the indocyanine green exam showed early saccular hypercianescence lesions in a context of dilated choroidal vessels still visible in late phases with surrounding hypocianescent area due to hemorrhage, confirming our hypothesis. We made the diagnosis of choroidal polypoidal vasculopathy in a naïve patient characterized by the presence of massive subretinal fluid, which we decide to treat with a loading dose of 3 monthly intravitreal injections (loading dose) of Aflibercept 8 mg. After the loading dose, the patient was checked monthly (T1, T2, T3 and T4 – fig.6) with OCT and BCVA in order to identify the maximum interval of treatment. At three months post loading the patient was still without disease activity and considering a minimal fluid recurrence at four months an intravitreal injection was given with shortening of 2 weeks of the subsequent interval (Q14) in the context of a Treat and extend regimen. In conclusion Aflibercept 8 mg has shown good efficacy both from anatomical parameters improvement (subretinal fluid resolution and reduction of PED height) and functional assessment (improvement of BCVA and its maintenance at 4 months of follow-up) in PCV, allowing to extend treatment’s interval up to a Q14 regimen with possible subsequent extension.