Bilateral Recurrent Choroidal Neovascularization in AZOOR

A 61-year-old man presented with recurrent bilateral peripapillary choroidal neovascularization (CNV), which was treated with intravitreal bevacizumab injections. Fundus autofluorescence revealed the typical acute zonal occult outer retinopathy (AZOOR) trizonal pattern, so the patient was started on immunosuppressive treatment with prednisone and methotrexate, and subsequently with mycophenolate mofetil due to recurrent inflammatory activity. While on immunosuppressive treatment, further CNV showing the “pitchfork sign” appeared in the right eye and required multiple bevacizumab injections due to persistent activity. The complication of CNV in AZOOR is very rare and treatment is a challenge. However, the combination of intravitreal anti-VEGF with immunosuppressive treatment could prevent the progression of the disease.