Unilateral Pseudo–Double Side-by-Side Lined Macular Neovascularizations in Pathologic Myopia

Pathologic myopia may be complicated by macular neovascularization (MNV) with atypical morphological configurations that can be challenging to characterize without multimodal imaging. A 50-year-old woman with pathologic myopia was examined due to a two-week history of newly developed left visual deterioration. Upon ophthalmological examination, her best-corrected Snellen visual acuity was hand motion in the right eye and 6/15 in the left eye. Slit-lamp examination revealed +4 nuclear sclerosis in the right eye, whereas the left eye appeared normal. Axial length measured by A-mode ultrasonography was 30.55 in the right eye and 28.04 in the left eye. The right fundus could be visualized only with indirect ophthalmoscopy, and there was severe patchy atrophy. There were two hyperpigmented side-by-side lined lesions indicating the presence of two macular neovascularizations at the left macula. Subfoveal spectral-domain optical coherence tomographic section depicted two hyperreflective materials located side by side at the outer retina, accompanied by mild intraretinal fluid. Optical coherence tomography angiography (OCTA) confirmed the presence of the pseudo-double MNV with an anatomical connection. The only good newly symptomatic left eye was treated with two intravitreal ranibizumab injections one month apart. The present case highlights that MNV associated with pathologic myopia may present with complex, pseudo-double configurations that can be accurately identified only through multimodal imaging. OCTA plays a crucial role in delineating the anatomical continuity and morphological characteristics of such lesions, thereby contributing to accurate diagnosis, treatment planning, and prognostic assessment.