Macular neovascularization associated with a focal choroidal excavation in a pediatric patient

A 13-year-old girl presented with a complaint of left eye central scotoma. Past medical history was unremarkable, and there were no associated systemic symptoms. Best-corrected visual acuity was 10/10 in the right eye (-2.00 -1.75 ×100°) and 1/10 in the left eye (-1.50 -2.25 ×80°). Macular spectral domain optical coherence tomography (SD-OCT) revealed subretinal and sub-retinal pigment epithelium hyperreflective material in the left eye with associated subretinal fluid, involving the foveal area, suggestive of an extrafoveal mixed type macular neovascularization (MNV), further evidenced through OCT angiography and fluorescein angiography. A focal choroidal excavation (FCE) was associated with this MNV. Thorough systemic investigation retrieved no abnormalities. A diagnosis of secondary FCE-related MNV was made. Treatment was initiated with anti-vascular endothelial growth factor intravitreal injections, with a total of 6 injections in a treat-and-extend regimen up to the most recent follow-up visit, 10 months after presentation. During follow-up, functional and structural improvement was observed, and there were no signs of recurrence of exudation.