First Author: D.Silva PORTUGAL
Co Author(s): M. Mota L. Colaco S. Pinto F. Silva I. Prieto
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To present the anatomical and functional outcomes of two patients with angioid streaks from our department.
Ophthalmology Department, Hospital Professor Doutor Fernando da Fonseca, Lisbon, Portugal
We reviewed the clinical records of two patients with angioid streaks from our department. Visual acuity, clinical findings and therapeutic approach was registered. Fluorescein angiography and optical coherence tomography were performed in all patients as well as systemic evaluation of underlying conditions.
Case 1: A 49 year-old woman with history of Hepatitis C and chronic mild leucopenia presents with vision loss of the right eye. Distance-corrected visual acuity (DCVA) of the right eye was hand movement and of the left eye was 10/10. Yellow papules and “plucked chicken” skin lesions compatible with pseudoxanthoma elasticum were found in the cervical skin. Typical lesions of angioid streaks were visible in both eyes, as well as subfoveal CNV associated with rupture of the retinal pigmentary epithelium (RPE), an area of subretinal haemorrhage and macular subretinal fibrosis. A protocol of three ranibizumab intravitreal injections (IVI) was proposed despite the reserved prognosis. Case 2: 48 year-old man presents with loss of vision of the left eye. DCVA in OD was 10/10 and 4/10 in the OS at presentation. A subfoveal lesion compatible with an acquired vitelliform lesion with associated rupture of the RPE and subretinal fluid was found on the left eye. Careful examination revealed angioid streaks in both eyes as well as “peau d’orange” changes in the temporal retina. Initial dermatological evaluation was normal but skin biopsy results are still ongoing. Intravitreal injections of ranibizumab (4) were administered, with a final visual acuity of 4/10.
Angioid streaks are generally asymtoptomatic but can involve the macular area and cause vision loss due to choroidal neovascularization and subretinal haemorrhage. Underlying systemic conditions are frequently undiagnosed and must be actively investigated in all patients. An association of angioid streaks with acquired vitelliform lesions has been documented rarely in patients with pseudoxantoma elasticum.