Peripapillary CNVM - 2026 02 13 - Albert Xiong, MD

This case reviews an 85-year-old woman with longstanding reduced vision and amblyopia in the left eye, who developed intermittent central visual symptoms described as a dot in the vision, especially in dim lighting. Imaging showed punctate drusen, peripapillary subretinal hyperreflectivity with exudates, and leakage on fluorescein angiography, raising concern for peripapillary choroidal neovascularization. The teaching focus is recognizing peripapillary CNVM as a form of choroidal neovascularization that arises near the optic nerve and may be asymptomatic unless fluid, hemorrhage, or exudation extends toward the macula. The differential diagnosis includes age-related macular degeneration, polypoidal choroidal vasculopathy, central serous chorioretinopathy, and pathologic myopia. Key imaging findings include subretinal or sub-RPE hyperreflective material on OCT, exudation, and leakage on fluorescein angiography. This case emphasizes the role of multimodal imaging in diagnosing and characterizing CNVM. Fluorescein angiography can demonstrate leakage patterns, while OCT and OCT-A help localize the lesion, assess associated fluid or exudation, and monitor response to treatment. Peripapillary CNVM has a variable natural history, ranging from stability or spontaneous involution to enlargement toward the fovea, hemorrhage, scarring, and vision loss. Treatment is most commonly with anti-VEGF therapy when active or vision-threatening, with photodynamic therapy or surgery rarely considered in selected cases. This case presentation is intended for educational and teaching purposes only and should not be interpreted as medical advice or as a recommendation for diagnosis or treatment. Patients with decreased vision, new central spots, distortion, retinal bleeding, macular fluid, or concerns about their eyes should seek care from a qualified eye care professional for a complete examination and individualized medical guidance.