A Brazilian case of extensive macular atrophy with pseudodrusen and non-exudative quiescent macular neovascularization

Purpose: To report a case of extensive macular atrophy with pseudodrusen (EMAP) complicated by a non-exudative quiescent type 1 macular neovascularization (MNV). Case description: A 65-years-old male patient complained of bilateral progressive visual loss and nyctalopia over the last ten years. Fundus examination showed in both eyes central foveal sparing geographic atrophy partially extending outside vascular arcades, reticular pseudodrusen (RPD), and mid-periphery pavingstone degenerations. On optical coherence tomography (OCT), RPD, basal laminar deposits, retinal pigmented epithelium and outer retinal atrophy were detected bilaterally. In left eye (LE), a perifoveal mid-reflective pigment epithelium detachment (PED) with no neovascular activity signs (e.g., macular hemorrhage, intraretinal/subretinal fluid, subretinal hyperreflective material) was found. Fluorescein angiography revealed in LE a hyperfluorescence coincident with PED without leakage on late phase. OCT-angiography displayed a pathological neovascular network consistent with a non-exudative type 1 neovascularization. No treatment was performed and the patient was closely followed. On last consultation six months later, MNV was stable with no identifiable activation signs. Based on these findings, a diagnosis of EMAP complicated by non-exudative quiescent type 1 neovascularization was hypothesized. Discussion: Similarly to age-related macular degeneration, EMAP could be associated to non-exudative neovascularization. Choriocapillaris loss could be the trigger for the development of vascular sprouts, representing the precursor of non-exudative type 1 MNV. Conclusion: This case-report supported the importance of at least six-months follow-up for NE-MNV in EMAP. Further studies are needed to confirm our result and to consolidate therapeutic management of MNV in this rare macular disorder.