First Author: P.Manuel Baptista PORTUGAL
Co Author(s): A. Abreu S. Monteiro M. Lume M. Furtado M. Macedo
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To analyse the safety and efficacy of anti-vascular endothelial growth factor (VEGF) agents for the treatment of choroidal neovascularization (CNV) in patients with angioid streaks.
Centro Hospitalar e Universitário do Porto (CHUP), Porto.
Retrospective chart review of eyes with CNV secondary to Angioid Streaks treated with intravitreal anti-VEGF drugs with a follow-up period superior to 12 months. Best-corrected visual acuity (BCVA) and macular thickness measured by spectral domain optical coherence tomography (Heidelberg spectralis SD-OCT) were evaluated at baseline and at the end of follow-up. Fluorescein angiography was performed at baseline and as needed during treatment. OCT-A and En face OCT were performed in all patients.
9 eyes (8 patients), with mean age of 59.2 years old, were included in this study. Three patients had pseudoxanthoma elasticum. Four eyes had subfoveal CNV, 3 had justafoveal CNV and 2 eyes had extrafoveal CNV. These patients were treated with a Pro Re Nata regimen of intravitreal anti-VEGF injections: mean of 8.6 injections for, on average, 26.8 months (range from 12-56). Five eyes were treated with only one drug. In 2 eyes previously treated in another Hospital (1 eye with ranibizumab and the other with Aflibercept) the therapy was switched to bevacizumab. These 2 eyes had inactive CNV at the end of follow-up. After persistent intraretinal and subretinal fluid on the OCT despite prior intravitreal bevacizumab injections in two eyes, therapy was switched to intravitreal ranibizumab (2 monthly injections) and Aflibercept (5 monthly injections) respectively, with good morphological and functional outcome. At the end of the follow-up, BCVA stabilized or improved in 7 eyes; macular thickness stabilized or decreased in 8; 4 still had active CNV. No adverse events were noted.
Intravitreal anti-VEGF drugs are safe and effective in improving or stabilizing vision and lesion morphology in patients with CNV secondary to angioid streaks.