Perifoveal exudative vascular anomalous complex (PEVAC) and its expanded spectrum have been recently elucidated by multimodal imaging. Although there is some clarity about its characteristic features and natural history, the cause remains unknown. Herein, the authors describe a hitherto unknown association with prepapillary arterial loops and suggest a possible hypothesis for the development of a PEVAC-like lesion and its response to treatment with thermal laser. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:974-978.]. Copyright 2018, SLACK Incorporated.