Choroidal Neovascular Membrane Secondary to Angioid Streaks in Polycythaemia Vera

A 60 year-old man with poorly controlled JAK2+ polycythaemia vera (PV) on hydroxyurea presented with progressive bilateral vision loss. Fundoscopy revealed bilateral choroidal neovascular membranes (CNVM) with subtle radial streaks emanating from the optic discs (A). Fundus autofluorescence (B) elegantly demonstrated the angioid streaks with striking perilesional hyperautofluorescence - a hallmark of RPE metabolic stress. On optical coherence tomography, the right eye showed active neovascularisation with intra- & subretinal fluid, responding favourably to intravitreal anti-VEGF therapy. The left eye exhibited atrophic changes precluding treatment. This case underscores a rare but sight-threatening complication of PV.