Advances in the study of perifoveal exudative vascular anomalous complex_Chinese Journal of Ocular Fundus Diseases

Authors：

Liang Yuchen , Duan Jialiang ,  Shang Qingli

Department of Ophthalmology, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;

Corresponding author：

Shang Qingli, Email: qinglishang2013@sina.cn

Keywords：

Review; Macular edema; Laser coagulation; Perifoveal exudative vascular anomalous complex

DOI：

10.3760/cma.j.cn511434-20200318-00146

Video：

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Abstract Full text Figures/Tables Video References Cited by

Perifoveal exudative vascular anomalous complex (PEVAC) are class of diseases characterized by isolated aneurysmal lesions of the perifovea with hemorrhage and hard exudates, which are found in recent years. Its pathogenesis and pathological process are not yet fully elucidated. The current consensus through multimodal imaging studies is that PEVAC is an idiopathic perifoveal retinal vascular abnormality with cystoid macular edema (CME) and hard exudate. It is not easily distinguished clinically from retinal microaneurysm due to diabetic retinopathy or retinal vein occlusion, aneurysmal telangiectasia, and type 3 macular neovascularization (stage Ⅰ). PEVAC is a partially self-healing property, and some aneurysms and CME may resolve on their own during follow-up period. Laser photocoagulation is an effective measure for the treatment of PEVAC. In the future, with the rapid development of imaging technology, the progress of research on pathogenesis and treatment strategies and the updating of theories are expected to provide more effective treatments for PEVAC.

Citation： Liang Yuchen, Duan Jialiang, Shang Qingli. Advances in the study of perifoveal exudative vascular anomalous complex. Chinese Journal of Ocular Fundus Diseases, 2022, 38(5): 415-419. doi: 10.3760/cma.j.cn511434-20200318-00146 Copy

1.	Querques G, Kuhn D, Massamba N, et al. Perifoveal exudative vascular anomalous complex[J]. J Fr Ophtalmol, 2011, 34(8): 559. DOI: 10.1016/j.jfo.2011.03.002.
2.	Sacconi R, Freund KB, Yannuzzi LA, et al. The expanded spectrum of perifoveal exudative vascular anomalous complex[J]. Am J Ophthalmol, 2017, 184: 137-146. DOI: 10.1016/j.ajo.2017.10.009.
3.	Mrejen S, Le HM, Nghiem-Buffet S, et al. Insights into perifoveal exudative vascular anomalous complex[J]. Retina, 2020, 40(1): 80-86. DOI: 10.1097/iae.0000000000002435.
4.	Bourhis A, Girmens JF, Boni S, et al. Imaging of macroaneurysms occurring during retinal vein occlusion and diabetic retinopathy by indocyanine green angiography and high resolution optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2010, 248(2): 161-166. DOI: 10.1007/s00417-009-1175-6.
5.	Verhoekx JSN, Smid LM, Vermeer KA, et al. Anatomical changes on sequential multimodal imaging in perifoveal exudative vascular anomalous complex[J]. Retina, 2021, 41(1): 162-169. DOI: 10.1097/IAE.0000000000002809.
6.	Sacconi R, Borrelli E, Bandello F, et al. Perifoveal exudative vascular anomalous complex in a highly myopic eye[J/OL]. Ther Adv Ophthalmol, 2020, 12: 2515841420947930[2020-09-11]. https://pubmed.ncbi.nlm.nih.gov/32964194/. DOI: 10.1177/2515841420947930.
7.	Siedlecki J, Vounotrypidis E, Vogt D, et al. Lamellar hole-associated epiretinal proliferation presenting with perifoveal exudative vascular anomalous complex[J]. Am J Ophthalmol Case Rep, 2019, 14: 112-116. DOI: 10.1016/j.ajoc.2019.03.008.
8.	Kim JH, Kim JW, Kim CG, et al. Characteristics of perifoveal exudative vascular anomalous complex in Korean patients[J]. Semin Ophthalmol, 2019, 34(5): 353-358. DOI: 10.1080/08820538.2019.1626450.
9.	Spaide RF, Barquet LA. Retinal capillary macroaneurysms[J]. Retina, 2019, 39(10): 1889-1895. DOI: 10.1097/iae.0000000000002406.
10.	López-Luppo M, Nacher V, Ramos D, et al. Blood vessel basement membrane alterations in human retinal microaneurysms during aging[J]. Invest Ophthalmol Vis Sci, 2017, 58(2): 1116-1131. DOI: 10.1167/iovs.16-19998.
11.	Zhang Z, Xu L, Wu Z, et al. Case report: perifoveal exudative vascular anomalous complex in a chinese patient with diabetes mellitus[J]. Optom Vis Sci, 2019, 96(7): 531-535. DOI: 10.1097/OPX.0000000000001401.
12.	Fernández-Vigo JI, Burgos-Blasco B, Dolz-Marco R, et al. Atypical perifoveal exudative vascular anomalous complex (pevac) with multifocal and bilateral presentation[J/OL]. Am J Ophthalmol Case Rep, 2020, 18: 100717[2020-04-21]. https://pubmed.ncbi.nlm.nih.gov/32368691/. DOI: 10.1016/j.ajoc.2020.100717.
13.	Corvi F, Corradetti G, Juhn A, et al. Long-term follow-up of perifoveal exudative vascular anomalous complex treated with intravitreal injections of anti-vascular endothelial growth factor and thermal laser photocoagulation[J/OL]. Am J Ophthalmol Case Rep, 2020, 20: 100883[2020-08-20]. https://pubmed.ncbi.nlm.nih.gov/33376832/. DOI: 10.1016/j.ajoc.2020.100883.
14.	Henriques J, Pinto F, Rosa PC, et al. Continuous wave milipulse yellow laser treatment for perifoveal exudative vascular anomalous complex-like lesion: a case report[J]. Eur J Ophthalmol, 2022, 32(1): 119-124. DOI: 10.1177/1120672120966564.
15.	Smid LM, Verhoekx JSN, Martinez Ciriano JP, et al. Multimodal imaging comparison of perifoveal exudative vascular anomalous complex and resembling lesions[J]. Acta Ophthalmol, 2021, 99(5): 553-558. DOI: 10.1111/aos.14650.
16.	Sacconi R, Borrelli E, Sadda S, et al. Nonexudative perifoveal vascular anomalous complex: the subclinical stage of perifoveal exudative vascular anomalous complex?[J]. Am J Ophthalmol, 2020, 218: 59-67. DOI: 10.1016/j.ajo.2020.04.025.
17.	Sacconi R, Cohen SY, Borrelli E, et al. Correspondence[J/OL]. Retina, 2019, 39(11): e48-e49[2019-11-01]. https://pubmed.ncbi.nlm.nih.gov/31116163/. DOI: 10.1097/iae.0000000000002567.
18.	Venkatesh R, Yadav NK, Bavaharan B, et al. Multimodal imaging in perifoveal exudative vascular anomalous complex with co-existent diabetic retinopathy[J]. Clin Exp Optom, 2019, 102(5): 528-532. DOI: 10.1111/cxo.12868.
19.	Parravano M, De Geronimo D, Scarinci F, et al. Diabetic microaneurysms internal reflectivity on spectral-domain optical coherence tomography and optical coherence tomography angiography detection[J]. Am J Ophthalmol, 2017, 179: 90-96. DOI: 10.1016/j.ajo.2017.04.021.
20.	Wang H, Chhablani J, Freeman WR, et al. Characterization of diabetic microaneurysms by simultaneous fluorescein angiography and spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2012, 153(5): 861-867. DOI: 10.1016/j.ajo.2011.10.005.
21.	Choi KE, Han S, Yun C, et al. Suspended scattering particles in motion using oct angiography in branch retinal vein occlusion disease cases with cystoid macular edema[J/OL]. Sci Rep, 2020, 10(1): 14011[2020-08-19]. https://pubmed.ncbi.nlm.nih.gov/32814784/. DOI: 10.1038/s41598-020-70784-7.
22.	Gass JD, Oyakawa RT. Idiopathic juxtafoveolar retinal telangiectasis[J]. Arch Ophthalmol, 1982, 100(5): 769-780. DOI: 10.1001/archopht.1982.01030030773010.
23.	Hartnett ME, Weiter JJ, Staurenghi G, et al. Deep retinal vascular anomalous complexes in advanced age-related macular degeneration[J]. Ophthalmology, 1996, 103(12): 2042-2053. DOI: 10.1016/s0161-6420(96)30389-8.
24.	Yannuzzi LA, Freund KB, Takahashi BS. Review of retinal angiomatous proliferation or type 3 neovascularization[J]. Retina, 2008, 28(3): 375-384. DOI: 10.1097/IAE.0b013e3181619c55.
25.	Yannuzzi LA, Negrão S, Iida T, et al. Retinal angiomatous proliferation in age-related macular degeneration. 2001[J]. Retina, 2012, 32 (Suppl 1): S416-434. DOI: 10.1097/iae.0b013e31823f9b3b.
26.	Freund KB, Ho IV, Barbazetto IA, et al. Type 3 neovascularization: the expanded spectrum of retinal angiomatous proliferation[J]. Retina, 2008, 28(2): 201-211. DOI: 10.1097/IAE.0b013e3181669504.
27.	Su D, Lin S, Phasukkijwatana N, et al. An updated staging system of type 3 neovascularization using spectral domain optical coherence tomography[J]. Retina, 2016, 36(Suppl 1): S40-49. DOI: 10.1097/iae.0000000000001268.
28.	Sacconi R, Sarraf D, Garrity S, et al. Nascent type 3 neovascularization in age-related macular degeneration[J]. Ophthalmol Retina, 2018, 2(11): 1097-1106. DOI: 10.1016/j.oret.2018.04.016.
29.	Ayachit AG, Sacconi R, Ayachit GS, et al. Perifoveal exudative vascular anomalous complex-like lesion as a complication of prepapillary arterial loops[J]. Ophthalmic Surg Lasers Imaging Retina, 2018, 49(12): 974-978. DOI: 10.3928/23258160-20181203-11.

1. Querques G, Kuhn D, Massamba N, et al. Perifoveal exudative vascular anomalous complex[J]. J Fr Ophtalmol, 2011, 34(8): 559. DOI: 10.1016/j.jfo.2011.03.002.
2. Sacconi R, Freund KB, Yannuzzi LA, et al. The expanded spectrum of perifoveal exudative vascular anomalous complex[J]. Am J Ophthalmol, 2017, 184: 137-146. DOI: 10.1016/j.ajo.2017.10.009.
3. Mrejen S, Le HM, Nghiem-Buffet S, et al. Insights into perifoveal exudative vascular anomalous complex[J]. Retina, 2020, 40(1): 80-86. DOI: 10.1097/iae.0000000000002435.
4. Bourhis A, Girmens JF, Boni S, et al. Imaging of macroaneurysms occurring during retinal vein occlusion and diabetic retinopathy by indocyanine green angiography and high resolution optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2010, 248(2): 161-166. DOI: 10.1007/s00417-009-1175-6.
5. Verhoekx JSN, Smid LM, Vermeer KA, et al. Anatomical changes on sequential multimodal imaging in perifoveal exudative vascular anomalous complex[J]. Retina, 2021, 41(1): 162-169. DOI: 10.1097/IAE.0000000000002809.
6. Sacconi R, Borrelli E, Bandello F, et al. Perifoveal exudative vascular anomalous complex in a highly myopic eye[J/OL]. Ther Adv Ophthalmol, 2020, 12: 2515841420947930[2020-09-11]. https://pubmed.ncbi.nlm.nih.gov/32964194/. DOI: 10.1177/2515841420947930.
7. Siedlecki J, Vounotrypidis E, Vogt D, et al. Lamellar hole-associated epiretinal proliferation presenting with perifoveal exudative vascular anomalous complex[J]. Am J Ophthalmol Case Rep, 2019, 14: 112-116. DOI: 10.1016/j.ajoc.2019.03.008.
8. Kim JH, Kim JW, Kim CG, et al. Characteristics of perifoveal exudative vascular anomalous complex in Korean patients[J]. Semin Ophthalmol, 2019, 34(5): 353-358. DOI: 10.1080/08820538.2019.1626450.
9. Spaide RF, Barquet LA. Retinal capillary macroaneurysms[J]. Retina, 2019, 39(10): 1889-1895. DOI: 10.1097/iae.0000000000002406.
10. López-Luppo M, Nacher V, Ramos D, et al. Blood vessel basement membrane alterations in human retinal microaneurysms during aging[J]. Invest Ophthalmol Vis Sci, 2017, 58(2): 1116-1131. DOI: 10.1167/iovs.16-19998.
11. Zhang Z, Xu L, Wu Z, et al. Case report: perifoveal exudative vascular anomalous complex in a chinese patient with diabetes mellitus[J]. Optom Vis Sci, 2019, 96(7): 531-535. DOI: 10.1097/OPX.0000000000001401.
12. Fernández-Vigo JI, Burgos-Blasco B, Dolz-Marco R, et al. Atypical perifoveal exudative vascular anomalous complex (pevac) with multifocal and bilateral presentation[J/OL]. Am J Ophthalmol Case Rep, 2020, 18: 100717[2020-04-21]. https://pubmed.ncbi.nlm.nih.gov/32368691/. DOI: 10.1016/j.ajoc.2020.100717.
13. Corvi F, Corradetti G, Juhn A, et al. Long-term follow-up of perifoveal exudative vascular anomalous complex treated with intravitreal injections of anti-vascular endothelial growth factor and thermal laser photocoagulation[J/OL]. Am J Ophthalmol Case Rep, 2020, 20: 100883[2020-08-20]. https://pubmed.ncbi.nlm.nih.gov/33376832/. DOI: 10.1016/j.ajoc.2020.100883.
14. Henriques J, Pinto F, Rosa PC, et al. Continuous wave milipulse yellow laser treatment for perifoveal exudative vascular anomalous complex-like lesion: a case report[J]. Eur J Ophthalmol, 2022, 32(1): 119-124. DOI: 10.1177/1120672120966564.
15. Smid LM, Verhoekx JSN, Martinez Ciriano JP, et al. Multimodal imaging comparison of perifoveal exudative vascular anomalous complex and resembling lesions[J]. Acta Ophthalmol, 2021, 99(5): 553-558. DOI: 10.1111/aos.14650.
16. Sacconi R, Borrelli E, Sadda S, et al. Nonexudative perifoveal vascular anomalous complex: the subclinical stage of perifoveal exudative vascular anomalous complex?[J]. Am J Ophthalmol, 2020, 218: 59-67. DOI: 10.1016/j.ajo.2020.04.025.
17. Sacconi R, Cohen SY, Borrelli E, et al. Correspondence[J/OL]. Retina, 2019, 39(11): e48-e49[2019-11-01]. https://pubmed.ncbi.nlm.nih.gov/31116163/. DOI: 10.1097/iae.0000000000002567.
18. Venkatesh R, Yadav NK, Bavaharan B, et al. Multimodal imaging in perifoveal exudative vascular anomalous complex with co-existent diabetic retinopathy[J]. Clin Exp Optom, 2019, 102(5): 528-532. DOI: 10.1111/cxo.12868.
19. Parravano M, De Geronimo D, Scarinci F, et al. Diabetic microaneurysms internal reflectivity on spectral-domain optical coherence tomography and optical coherence tomography angiography detection[J]. Am J Ophthalmol, 2017, 179: 90-96. DOI: 10.1016/j.ajo.2017.04.021.
20. Wang H, Chhablani J, Freeman WR, et al. Characterization of diabetic microaneurysms by simultaneous fluorescein angiography and spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2012, 153(5): 861-867. DOI: 10.1016/j.ajo.2011.10.005.
21. Choi KE, Han S, Yun C, et al. Suspended scattering particles in motion using oct angiography in branch retinal vein occlusion disease cases with cystoid macular edema[J/OL]. Sci Rep, 2020, 10(1): 14011[2020-08-19]. https://pubmed.ncbi.nlm.nih.gov/32814784/. DOI: 10.1038/s41598-020-70784-7.
22. Gass JD, Oyakawa RT. Idiopathic juxtafoveolar retinal telangiectasis[J]. Arch Ophthalmol, 1982, 100(5): 769-780. DOI: 10.1001/archopht.1982.01030030773010.
23. Hartnett ME, Weiter JJ, Staurenghi G, et al. Deep retinal vascular anomalous complexes in advanced age-related macular degeneration[J]. Ophthalmology, 1996, 103(12): 2042-2053. DOI: 10.1016/s0161-6420(96)30389-8.
24. Yannuzzi LA, Freund KB, Takahashi BS. Review of retinal angiomatous proliferation or type 3 neovascularization[J]. Retina, 2008, 28(3): 375-384. DOI: 10.1097/IAE.0b013e3181619c55.
25. Yannuzzi LA, Negrão S, Iida T, et al. Retinal angiomatous proliferation in age-related macular degeneration. 2001[J]. Retina, 2012, 32 (Suppl 1): S416-434. DOI: 10.1097/iae.0b013e31823f9b3b.
26. Freund KB, Ho IV, Barbazetto IA, et al. Type 3 neovascularization: the expanded spectrum of retinal angiomatous proliferation[J]. Retina, 2008, 28(2): 201-211. DOI: 10.1097/IAE.0b013e3181669504.
27. Su D, Lin S, Phasukkijwatana N, et al. An updated staging system of type 3 neovascularization using spectral domain optical coherence tomography[J]. Retina, 2016, 36(Suppl 1): S40-49. DOI: 10.1097/iae.0000000000001268.
28. Sacconi R, Sarraf D, Garrity S, et al. Nascent type 3 neovascularization in age-related macular degeneration[J]. Ophthalmol Retina, 2018, 2(11): 1097-1106. DOI: 10.1016/j.oret.2018.04.016.
29. Ayachit AG, Sacconi R, Ayachit GS, et al. Perifoveal exudative vascular anomalous complex-like lesion as a complication of prepapillary arterial loops[J]. Ophthalmic Surg Lasers Imaging Retina, 2018, 49(12): 974-978. DOI: 10.3928/23258160-20181203-11.

Chinese Journal of Ocular Fundus Diseases

Advances in the study of perifoveal exudative vascular anomalous complex

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