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L. D. Charkoudian, M. Hadziahmetovic, G. Malik, N. J. Volpe, J. L. Dunaief, S. L. Fine; Sequential Bilateral Idiopathic Choroidal Neovascularization and Intracranial Arteriovenous Malformation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):956.
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To describe an unusual case of sequential bilateral idiopathic choroidal neovascularization (CNV) and intracranial arteriovenous malformation (AVM) in a young patient and to hypothesize potential etiologies.
Case description including anti-vascular endothelial growth factor (VEGF) staining of arteriovenous malformation and serum VEGF level measurement.
A healthy young emmetropic female presented with acute onset of distortion in each eye, occurring sequentially within a three year period. Dilated ophthalmoscopy and fluorescein angiography at the time of presentation of distortion in each eye revealed peripapillary idiopathic CNV.
Shortly after presentation of CNV in the second eye, the patient developed acute onset of neurologic symptoms and was diagnosed with an intracranial AVM with hemorrhage. The AVM was successfully resected. Anti-VEGF staining of the arteriovenous malformation revealed diffuse labeling of the specimen, suggesting substantially increased VEGF levels at the time of resection.
A) Anti-VEGF labeling (purple). B) Control section with primary antibody omitted. Scale bar indicates 50uM.A serum VEGF level drawn approximately a decade after AVM resection yielded less than 7 pg/mL (normal 9-86 pg/mL).
The rarity and rapid sequential onset of the patient’s individual neovascular conditions would make them unlikely to occur by chance alone. Given the increasingly apparent role that VEGF plays in both conditions, further research may be warranted to better understand a potential association between these and other coexisting neovascular conditions.
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