Choroidal ischemia drives macular neovascularization in persistent placoid maculopathy

PURPOSE: To describe a case of persistent placoid maculopathy (PPM) complicated by macular neovascularization (MNV) that developed in areas of prior choroidal ischemia as illustrated with sequential optical coherence tomography angiography. OBSERVATIONS: A 65-year-old man presented with unilateral decreased vision and creamy plaque-like macular lesions in both eyes (OU) upon fundus examination. Optical coherence tomography angiography (OCTA) demonstrated inner choroidal ischemia, corresponding to the placoid lesions, that persisted for several months consistent with a diagnosis of PPM. The patient was treated with immunosuppressive therapy, but the areas of inner choroidal ischemia gave rise to the development of MNV in each eye warranting serial antiVEGF therapy. CONCLUSIONS AND IMPORTANCE: OCTA is a useful tool for the diagnosis and follow up of PPM patients and can demonstrate areas of persistent inner choroidal ischemia that can drive the development of choroidal neovascularization.