Spectral-domain optical coherence tomography detects choroidal neovascularization by its indirect effects on the retina.1 However, actual subretinal pigment epithelium (RPE) (type 1) or subretinal (type 2)2 new vessels often are not noted.
A man in his 60s was diagnosed with a polypoidal choroidal vasculopathy pattern of choroidal neovascularization and treated with photocoagulation of an extrafoveal feeder vessel combined with anti–vascular endothelial growth factor agents. Indocyanine green angiography showed the neovascularization and 2 small vessels crossing an area of RPE atrophy caused by prior photocoagulation (Figure, A). Using enhanced depth imaging and an averaging of 100 B-scans to reduce speckle noise, a sinusoid luminal structure with low to moderate reflectivity adjacent to an area of subretinal and intraretinal fluid was identified originating in the choroid and crawling between the Bruch membrane and the sub-RPE space (Figure, B). These findings are consistent with the presence of type 1 neovascularization.
Biarnés M, Monés J. Direct Visualization of a New Choroidal Vessel on Spectral-Domain Optical Coherence Tomography. JAMA Ophthalmol. 2016;134(3):e155017. doi:10.1001/jamaophthalmol.2015.5017