We are very grateful for the interest shown in our article by the above contributor. Fundus fluorescein angiography (FFA) was indeed performed and although the images demonstrated an occult leakage, the quality was such that detailed interpretation was not possible due to the masking effect of the blood. Your contributors are correct in that it has long been known that indocyanine green angiography has long been demonstrated as being superior to FFA in macular degeneration cases involving hemorrhages although, in this case, the images were also deemed unhelpful due to the blood.
Whereas the EVEREST study did indeed show statistically significant differences in rates of polyp regression in polypoidal choroidal vasculopathy (PCV), the functional outcomes did not demonstrate any significant differences between photodynamic therapy with verteporfin (PDT) and intravitreal ranibizumab. Indeed, it has been recently suggested that intravitreal ranibizumab offers superior functional outcomes over PDT in treating patients with PCV. In the case of our patient, however, the visual acuity did not improve beyond counting fingers despite intravitreal ranibizumab therapy, and the jury is probably still out in knowing the best course of action in patients with PCV presenting with significant hemorrhage, although it is probably safe to deduce that the functional outcome is not likely to be satisfactory if the hemorrhage is very large in any case.
We wholeheartedly agree with the comments that this kind of presentation of macular hemorrhage is in all probability underreported and under recognized and are grateful for the supportive comments that serve to further highlight this issue.
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