“Hematocrit Sign” in PEVAC Lesion
A 68-year-old lady with no history of any known systemic disease like diabetes or hypertension visited a tertiary eye care hospital for regular check-up. She had a posterior chamber intraocular lens in her left eye (LE). Her vision was 20/20, N6 and 20/30, N8 in right eye (RE) and LE respectively. Anterior segment examination was normal. The RE fundus was normal. The LE fundus showed a couple of large perifoveal microaneurysms with surrounding intraretinal fluid. A clinical diagnosis of perifoveal exudative vascular anomalous complex (PEVAC) was made. Multimodal imaging with multicolor imaging, optical coherence tomography (OCT), fluorescein and indocyanine green angiography, and enface OCT was done. The images in Figures 1 and 2 confirmed the clinical diagnosis of PEVAC. Laser photocoagulation to the lesions was performed without any success.
Aneurysmal lesions arising from the retinal/choroidal vasculature include retinal artery macroaneurysm, polypoidal choroidal vasculopathy (PCV), microaneurysms, MacTel Type 1, and PEVAC.1,2 These lesions have hyperreflective walls and a clear or blood-filled lumen. “Haematocrit sign” in PCV was described on enface OCT images as round polyp with blood corpuscles sedimented inferiorly giving rise to a horizontal fluid level within the polyp.1 In this image, enface OCT scans showed similar “horizontal fluid level” within the aneurysmal PEVAC lesion. To our knowledge, “hematocrit sign” in PEVAC has not been documented in the literature.
1. Imamura Y, Engelbert M, Iida T, et al. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol
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2. Sacconi R, Freund KB, Yannuzzi LA, et al. The expanded spectrum of perifoveal exudative vascular anomalous complex. Am J Ophthalmol