Clinical characteristics and combined treatment for choroidal neovascularization secondary to angioid streaks

Abstract

Objective To investigate the clinical characteristics and evaluate photodynamic therapy treatment combined with intravitreal injection of Lucentis for choroidal neovascularization secondary to angioid streaks. Methods This was an interventional retrospective analysis of 21 patients (42 eyes). For clinical data, best corrected visual acuity (BCVA), fundus appearance, fundus fluorescence angiography (FFA) , indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were assessed. Twenty-two eyes of 18 patients with macular choroidal neovascularizaiton (CNV) were treated first with photodynamic therapy (PDT) and then with an intravitreal injection of Lucentis. The patients were followed up for at least 12 months. Another injection was given if one of the following appeared: decreased visual acuity, new macular lesions, subretinal or intraretinal fluid, or CNV leakage. Data were analyzed using an independent-samples t test or a paired-samplest test. Results Both eyes of all 21 patients were involved. Only 5 patients (24%) had complications with hologathy. Males were more affected (76%). Of all the patients, 18 cases (86%) were diagnosed with CNV secondary to AS. BCVA was much worse in eyes with CNV. At the final follow-up after the combination treatment, BCVA had improved 10.4 characters. OCT showed macular retinal thickness decreased from 338.4±55.2 μm at baseline to 212.6±36.2 μm. FFA (ICGA) showed CNV leakage in 15 eyes (68%) had disappeared completely, and 5 eyes had scar staining. All patients received 1 treatment of PDT and a mean 3.2 intravitreal injections. Macular subretinal hemorrhage presented in 1 patient after PDT, but was absorbed completely after intravitreal injection. Five patients presented with transient elevated intraocular pressure and 4 patients had subconjunctival hemorrhage but all recovered quickly. No other ocular or adverse reactions occurred. Conclusion Angioid streaks present a special fundus appearance, and FFA(ICGA) is valuable in the diagnosis. A considerable proportion of patients are affected with CNV secondary to AS. PDT treatment combined with intravitreal injection of Lucentis is effective in preventing disease progression, improving visual acuity, and reducing CNV leakage. Adverse reactions are mild. Key words: Angioid streaks; Choroidal neovascularization; Fluorescein angiography; Photochemo therapy; Vascular endothelial growth factor A