Treatment of peripheral exudative hemorrhagic chorioretinopathy by intravitreal injections of Aflibercept: report of 4 cases

Purpose Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare disorder characterized by subretinal or sub‐pigment epithelial hemorrhage and exudation localized outside the macular region.Some authors consider PEHCR as the peripheral version of age‐related macular degeneration while others believe PEHCR is a specific variant of polypoidal choroidal vasculopathy (PCV). Methods We report 4 cases of PEHCR (3 women and 1 man) treated by intravitreal injections of Aflibercept. The mean age was 78 years (range 62–83 years). In all cases the presence of PCV was confirmed with indocyannine green angiography. Examination revealed peripheral subretinal or sub‐pigment epithelial hemorrhage with exudation extented into the macula in all patients. After 2 or 3 intravitreal injections of Aflibercept, PEHCR lesions and submacular exudation significantly regressed. Results Generally PEHCR has a favorable prognosis, hovewer vision can be threated because of subretinal hemorrhage and fluid extension into the macula. In cases in which the macula appears threatened, intravitreal antivascular endothelial growth factor therapy and/or laser‐based therapies may be indicated. Peripheral lesion can be difficult to reach with photodynamic therapy. Intravitreal Aflibercept, with its mechanism of action, may be an effective treatment option to reduce subretinal fluid. Conclusions PEHCR is not well‐recognized by the ophthalmologist and is often misinterpreted as a choroidal melanoma. To our knowledge this is the first report of Aflibercept use and efficacy in this indication.