Intra-Vitreous Injections of Bevacizumab in Choroidal Neovascularization Complicating Best Vitelliform Macular Dystrophy: Case Report of a Child

Case Report

Austin J Clin Case Rep. 2021; 8(7): 1220.

Intra-Vitreous Injections of Bevacizumab in Choroidal Neovascularization Complicating Best Vitelliform Macular Dystrophy: Case Report of a Child

Elkhoyaali A*, Jeddou I, Zerrouk R, Khanaouchi N, Mouzari Y, Reda K and Oubaaz A

Ophthalmology Department, Mohamed V University, Military Training Hospital Mohamed V, Rabat, Morocco

*Corresponding author: Adil Elkhoyaali, Department of Ophtalmology, Mohamed V University, Military Hospital Mohamed V, Rabat, Morroco

Received: May 25, 2021; Accepted: June 16, 2021; Published: June 23, 2021

Abstract

A 15-year-old child followed for Best vitelliform macular dystrophy presented to the clinic with an abrupt visual impairment of his left eye. Fundus examination showed bilateral vitelliform lesions, with serous retinal detachment and adjacent retinal hemorrhage in the left eye. Fluorescein angiography and optical coherence tomography confirmed the diagnosis of type-2 choroidal neovascularization complicating the Best disease. The juxtafoveal location of the choroidal neovascularization prompted us to realize monthly intra-vitreous injections of bevacizumab. After the fourth injection, we observed visual and anatomical improvement that remained stable after a 12-month follow-up. It’s important to look for complications in front of a sudden decrease in visual acuity in Best disease.

Keywords: Best disease; Macular dystrophy; Choroidal neovascularization; Intra-vitreous injections; Bevacizumab

Introduction

Best Vitelliform Macular Dystrophy (BVMD) is among the most common genetic macular degeneration typically occurring bilaterally with juvenile-onset [1]. The development of choroidal neovascularization (CNV) is an uncommon complication with no proven effective treatment modality at this time.

Case Presentation

We report the case of a child followed for BVMD who presented to the ophthalmology clinic for a sudden visual impairment that happened to be caused by choroidal neovascularization.

Results

We report the case of a 15-year-old male diagnosed with BVMD seven years earlier based on electrophysiological examination (perturbed electro-oculography and subnormal Arden ratio). Visual acuity remained stable at 20/32 in both eyes during five years, then the patient was lost to follow-up for 30 months, before attending the ophthalmology clinic for a bilateral rapidly progressive decrease of vision and metamorphopsia, mostly in the left eye.

Best-Corrected Visual Acuity (BCVA) was 20/40 OD and 20/160 OS. Intraocular pressure was normal. Fundus examination revealed bilateral foveal fibrotic vitelliform lesion, surrounded by a serous retinal detachment (SRD) and an inferior macular microhemorrhage in the left eye (Figure 1).