Abstract
A patient with a medical history significant only for hyperlipidemia presented to the Bascom Palmer Eye Institute emergency department with progressively worsening bilateral blurry vision over a two-week period. He reported a minor motor vehicle accident two months prior but had no previous ocular history. Best-corrected visual acuity was 20/70 in both eyes, intraocular pressures were normal, and the anterior segment examination was unremarkable bilaterally. Posterior segment examination demonstrated extensive exudative and hemorrhagic changes, including areas of retinal elevation, hard exudates, subretinal fibrosis, and hemorrhage in the right eye, with exudates, scarring, and pigmentary changes along the vascular arcades in the left eye. The relative absence of significant systemic or ocular risk factors and the atypical fundus appearance prompted further multimodal retinal imaging and diagnostic evaluation. Following diagnosis with polypoidal choroidal vasculopathy with lesions also present outside the macula, the patient underwent intravitreal anti-VEGF therapy. His clinical course was complicated by multiple prolonged lapses in follow-up. Initially, he received four intravitreal aflibercept injections in the right eye and one injection in the left eye before being lost to follow-up for approximately 18 months. Upon return, he received an additional injection in the right eye but was again lost to follow-up for two years. He later re-presented with a retinal pigment epithelium tear and a large submacular hemorrhage in the left eye, requiring three additional intravitreal aflibercept injections. Despite recurrent disease activity and inconsistent treatment adherence, long-term visual outcomes remained favorable. At final follow-up, visual acuity improved from 20/70 to 20/30 in the right eye and from 20/70 to 20/60 in the left eye. This case highlights the importance of careful clinical examination, multimodal imaging, and ongoing surveillance in patients with chronic exudative and hemorrhagic macular disease, particularly when follow-up is interrupted.
Presentation Date: 07/23/2026
Issue Date: 07/24/2026
