Peripapillary Pachychoroid Neovasculopathy (PPN)

Colour fundus photograph and red-free image (left eye)

Retinal photos show widespread large drusen with pigmentary changes.

Fundus autofluoresence (FAF) imaging

FAF imaging shows hyper-AF superior to the disc, co-located with the subretinal fluid and likely CNV. Macular drusen is also associated with changes in background

Spectralis OCT line scans (left eye)

Image 1 shows a small area of sub-retinal fluid and a large, dilated choroidal vessel adjacent to this area.

Image 2 shows a flat, irregular PED (FIPED) with adjacent area of subretinal fluid. The reflectivity of the PED suggests a fibrotic or vascular nature.

OCT angiography (left eye)

OCTA shows suspicious flow signal within the PED in both 2023 and 2024, however the more recent image is associated with sub-retinal fluid indicating active exudation. Central vision is not being threatened at this stage. Note that the temporal scleral crescent complicates the differentiation of the normal peripapillary vasculature from the supero-nasal neovascularisation.