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Choroidal Neovascularization and Chorioretinal Anastomoses Following Laser Treatment of a Secondary Vasoproliferative Tumor

Christine Y. Chen, PhD1,2,3,4; Michael Engelbert, MD3,4,5; K. Bailey Freund, MD3,4,5,6; Carol L. Shields, MD7; Gaetano Barile, MD8,9
[+] Author Affiliations
1Department of Surgery, Monash University, Melbourne, Australia
2Centre for Eye Research Australia, University of Melbourne, Australia
3Vitreous Retina Macula Consultants of New York, New York
4LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
5Department of Ophthalmology, New York University School of Medicine, New York
6Department of Ophthalmology, Columbia University, New York, New York
7Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
8Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York, New York
9now with Hofstra North Shore–LIJ School of Medicine, Hempstead, New York
JAMA Ophthalmol. 2014;132(12):1488-1490. doi:10.1001/jamaophthalmol.2014.3297.
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Extract

Laser photocoagulation–induced choroidal neovascularization (CNV) is an uncommon iatrogenic complication following thermal laser treatment for diabetic macular edema and proliferative diabetic retinopathy.1 Disruption of the retinal pigment epithelium–Bruch membrane complex due to intense laser energy presumably leads to the development of CNV.1,2 We report a dramatic case of laser-induced CNV initially associated with a chorioretinal mass lesion that displayed characteristics of an atypical secondary vasoproliferative tumor. The chorioretinal lesion evolved to anastomose extensively with the retinal vasculature.

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Figure 1.
Multimodal Imaging of the Chorioretinal Lesion

A, Ultra–wide-field retinal color fundus photograph reveals dense and heavy laser scars with a raised pale vascular mass located along the infratemporal arcade with lipid exudate (Optos 200TX). B, Close-up view of the vascular lesion shows that it originated at the edge of laser scars with telangiectatic capillary on the surface (Topcon TRC-50DX). Green arrow indicates the optical coherence tomography section for D; yellow arrow, optical coherence tomography section for E. C, This lesion is hyperfluorescent on fluorescein angiography without an identifiable feeder vessel and appears to arise from the subretinal space or the retinal pigment epithelium. D, The lesion shows heterogeneity, loss of normal retinal architecture, and an epiretinal membrane on spectral-domain enhanced depth imaging optical coherent tomography (Heidelberg Spectralis HRA+OCT). E, Secondary cystoid macular edema is also present on spectral-domain enhanced depth imaging optical coherent tomography (Heidelberg Spectralis HRA+OCT).

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Figure 2.
Multimodal Imaging Demonstrates the Anastomoses Between the Chorioretinal Lesion and the Retinal Vasculature

The preretinal vascular network extends toward the fovea from the infratemporal arcade and forms part of the vascular supply within the macular region on a color fundus photograph (A) and fluorescein angiography (arrow indicates the optical coherence tomography section for C) (B). C, This preretinal vascular network within an epiretinal membrane appears to communicate with the infratemporal vascular mass (arrowhead) on swept-source optical coherence tomography (Topcon DRI-1 Atlantis).

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Real-Time Fluorescein Angiography

Real-time fluorescein angiography demonstrates that the extensive vascular network including the chorioretinal lesion was filled by the retinal circulation.

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