It’s not always diabetes..

This 47yo male patient was referred for a second opinion for CME/CMO in his LE. ⁠
He had a 6 month history of mild blurring and distortion. ⁠
Ocular and medical history was unremarkable. He denies any cardiovascular risk factors including diabetes, hypertension, hyperlipidaemia and smoking⁠
On examination his vision was RE 6/5, LE 6/15 and the only finding in either eye was a large dilated microaneurysm inferotemporal to the fovea and some scattered exudates.⁠
OCTA shows the large aneurysmal dilation in the inner retinal layers coming off the Superficial Capillary Plexus with associated intraretinal oedema and exudates on the structural OCT B-scan and the dilatation at the inferotemporal macula on the OCTA Enface.
Thorough inflammatory and cardiovascular workup was performed with the family physician with no evidence of DM, HTN or other cardiovascular or inflammatory risk factors. ⁠
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This patient was diagnosed with Perifoveal Exudative Vascular Anomalous Complex (PEVAC) which is a recently described (G.Querques, 2011) and uncommon macular disorder defined by the presence of a large unilateral, isolated, perifoveal aneurysm, in otherwise healthy patients. It’s important to recognise as the exudation doesn’t usually respond to intravitreal anti-VEGF injections.

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