First Author: C.Vale PORTUGAL
Co Author(s): M.J. Furtado M. Macedo M. Lume A. Meireles 0 0 0 0 0 0 0 0 0
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To report the long-term follow-up and management of angioid streaks complicated with macular choroidal neovascularization (CNVM).
Ophthalmology Department of Hospital de Santo António – Centro Hospitalar do Porto, Portugal, a tertiary wealth care center
Case report of 3 patients with bilateral angiod streaks (AS) complicated with CNVM confirmed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Treatment efficacy was measured by changes in Best corrected visual acuity (BCVA), OCT and FFA.
In Case 1, a patient with AS associated with Pseudoxanthoma elasticum (PXE), with a follow-up period of 11 years, photodynamic therapy (PDT) was applied in the first affected eye before anti-vascular endothelial growth factor (VEGF) treatment was available and intravitreal ranibizumab when the fellow eye was affected. Change in BCVA (initial vs. final visit BCVA; ETDRS chart): right eye (RE): loss of 60 letters / left eye (LE): loss of 65 letters Case 2, a patient with idiopathic AS, with a follow-up period of 3.5 years was treated with intravitreal ranibizumab after CNVM development in both eyes. Change in BCVA: RE: 0 letters / OS: loss of 15 letters In Case 3, a patient with AS associated with PXE, with a follow-up period of 2 years, developed an unilateral CNVM which was treated with a single injection of intravitreal ranizumab, with vision improvement and inactivation of CNVM with no need for retreatments during the follow-up period. Change in BCVA case 3: RE: gain of 10 letters
Anti- VEGF appears to be a promising treatment of CNVM secondary to AS. As recurrence rate is high, a regular monitoring for a long period of time is mandatory. Anti- VEGF treatment, despite being a major breakthrough in the treatment of CNVM, still has some limitations when addressing AS patients as scarring and atrophy of RPE may still compromise visual prognosis.