Intravitreal Bevacizumab for Nonsubfoveal Choroidal Neovascularization Associated With Angioid Streaks
Maurízio Battaglia ParodiPierluigi IaconoCarlo La SpinaLuigi BerchicciFabrizio ScottiAnita LeysUgo IntroiniFrancesco Bandello
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Angioid streaks
Choroidal neovascularization (CNV) belongs to the rare retinal disorders in children. Authors present 3 cases of CNV, which were diagnosed in patients between 12-15 years of age (2 females and 1 male). Complete ophthalmological examination including fluorescein angiography, indocyanine angiography and optical coherence tomography were performed in all cases. Laboratory tests to exclude the systemic diseases were also done. CNV in young people maybe a result of high myopia, angioid streaks, ocular histoplasmosis, trauma or it could be idiopathic. In our series, we found idiopathic CNV in 2 eyes and 1 CNV after traumatic choroidal break. Stabilization of visual acuity was achieved after argon laser treatment in 2 cases.
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Purpose To present a case of nonexudative choroidal neovascularization secondary to angioid streaks in a patient with pseudoxanthoma elasticum. The lesion was monitored over an 8-month period with the use of optical coherence tomography angiography. Methods Case report. Results The neovascular tissue area increased by 0.160 mm 2 over a period of 8 months without any sign of exudation seen on optical coherence tomography or fluorescein angiography. Conclusions To our knowledge, this is the first report of a nonexudative choroidal neovascularization secondary to angioid streaks. Given that once a patient with angioid streaks develops choroidal neovascularization in one eye there is a high risk of bilateral involvement within a short amount of time, optical coherence tomography angiography can prove a useful tool for monitoring such lesions over time.
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Purpose: To report on the five-year follow-up of ranibizumab therapy for choroidal neovascularization (CNV) secondary to angioid streaks (AS) in pseudoxanthoma elasticum (PXE).
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Pseudoxanthoma Elasticum
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Purpose To report the efficacy of intravitreal injection of bevacizumab 1.25 mg (IVB) in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks (AS). Methods Case review of two patients with CNV secondary to AS treated with three IVB with a 1-year follow-up. Results In both patients after 1 year fluorescein angiography and optical coherence tomography showed complete inactivity of the CNV and the ophthalmologic examination revealed stabilization of the visual acuity. Conclusions The IBV appeared to be an effective and safe treatment for CNV secondary to AS resulting in a long-term CNV inactivation. Further long-term studies in this type of lesion are desirable.
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Pseudoxanthoma Elasticum
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Angoid streaks are linear crack-line dehiscences of Bruch's membrane. Choroidal neovascularization is the most serious complication of angioid streaks. The authors try to determine the incidence of neovascular macular degeneration in angioid streaks, their detection and treatment. A retrospective study of 26 eyes of 13 patients with angioid streaks was performed, 6 of whom had macular complications and 3 had subretinal neovascular membranes. Indocyanine green angiography is an adjunctive diagnostic tool in the detection of subretinal neovascular membranes in angioid streaks. Laser photocoagulation of choroidal neovascularization in angioid streaks may end the choroidal neovascularization and help stabilize visual acuity.
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Pseudoxanthoma elasticum (PXE) is a rare, systemic disease with typical ophthalmological findings including angioid streaks (AS) (represent breaks in the Bruch's membrane). A serious and common complication of AS is the development of choroidal neovascularization (CNV), which can result in significant and irreversible vision loss.
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Pseudoxanthoma Elasticum
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PURPOSE: To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS: Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS: The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION: Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.
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