Objective To compare and observe the multimodal imaging and clinical characteristics of non-exudative and exudative parafoveal vascular anomaly complex (PVAC). MethodsA retrospective observational study. From January 2021 to March 2025, 12 patients (12 eyes) diagnosed with PVAC at The Eye Hospital of Nanjing Medical University were included in the study. Among them, 7 were male and 5 were female, all with unilateral onset; the patients' age was (63.8±8.8) years. All affected eyes underwent examinations including best corrected visual acuity (BCVA), fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), and fluorescein fundus angiography (FFA). BCVA was examined using a standard logarithmic visual acuity chart and converted to the smallest resolvable angle logarithm (logMAR) visual acuity for statistical analysis. Based on the presence or absence of exudation and edema, the affected eyes were classified into the exudative PVAC (ePVAC) group (7 cases, 7 eyes) and the non-exudative PVAC (nePVAC) group (5 cases, 5 eyes). The 5 eyes in the nePVAC group all received conservative treatment; in the ePVAC group, 1 eye received intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs combined with navigation laser photocoagulation, 3 eyes received simple intravitreal injection of anti-VEGF drugs, and the other 3 eyes received conservative treatment. After treatment, the follow-up time for the nePVAC group and the ePVAC group was (9.60±4.32) months and (8.14±4.53) months, respectively. At the follow-up, the same equipment and methods as at the first visit were used for reexamination. Comparative analysis of the multimodal imaging features and treatment responses of the two groups of affected eyes was conducted. Group comparison was performed using the Mann-Whitney U test. ResultsThe ages of patients in the ePVAC group and the nePVAC group were (67.7±7.3) and (58.4±8.4) years old, respectively. The logMAR BCVA was 0.67±0.439 and 0.16±0.055, respectively. The central macular thickness (CMT) was (296.6±87.8) μm and (213.8±19.2) μm, respectively. Compared with the nePVAC group, the patients in the ePVAC group were older (Z=?1.81), the CMT was thicker (Z=?2.19), and the BCVA was lower (Z=?2.62). The age difference was not statistically significant (P=0.07), while the differences in CMT and BCVA were statistically significant (P＜0.05). OCT and OCTA examinations showed that single or multiple oval tubular-like structures with strong reflection could be seen around the macular fovea in all affected eyes, and blood flow signals could be detected within them. The lesions simultaneously involved the superficial and deep capillary plexuses of the retina, and the capillary density around the lesions was sparse. FFA examination showed that there was no obvious fluorescein leakage in the nePVAC group in the late stage, while there was obvious fluorescein leakage in the ePVAC group in the late stage. At the last follow-up, one eye that received anti-VEGF drug combined with navigation laser photocoagulation treatment, the BCVA improved from 0.25 to 0.5, the macular edema subsided, and the tumor shrank; three eyes that received only anti-VEGF drug treatment, the BCVA improved from 0.3, 0.03, and 0.3 to 0.5, 0.15, and 0.4, respectively, and the macular edema subsided; eight eyes that received conservative treatment, the lesions remained stable during the follow-up period, and there were no significant changes in vision and macular structure. ConclusionsCompared with nePVAC, patients with ePVAC tend to be older and have worse baseline visual acuity. Ophthalmoscopically, both groups present with single or multiple tumor-like parafoveal lesions. OCT reveals oval luminal structures with hyperreflective walls, with or without hard exudates and subretinal fluid, and blood flow signals are detectable within these lesions. FFA in the late phase shows no obvious fluorescein leakage in nePVAC, while marked fluorescein leakage is observed in ePVAC.