Polypoidal Choroidal Vasculopathy with Active Subretinal Neovascularization

68 year-old African American male was examined when he complained of blurred vision of the left eye and a paracentral scotoma. The visual acuity was 20/25. A peripapillary choroidal neovascular membrane was found. Fluorescein angiogram (FA), Indocyanine green (ICG) and SD-OCT were obtained. Frame A is an FA of the left eye, showing active fluorescein leakage temporally to the disc (red arrow). The ICG (frame B), shows deeper choroidal polyps, indicated by the yellow arrows, typical of idiopathic polypoidal choroidal vasculopathy. SD-OCT of the left eye shows a pigment epithelial detachment (green arrow) adjacent to the disc. Overlying subretinal fluid extends toward the macula. SD-OCT of the right eye shows a normal macula. Intravitreal aflibercept was administered on this day and a 1 month follow up was scheduled. Photodynamic therapy is a probable next step to reduce the need for so many intravitreal injections.