Choroidal Neovascularization In Angioid Streaks Research Articles

Long-Term Follow-Up of Choroidal Neovascularization due to Angioid Streaks with pro re nata Intravitreal Anti-VEGF Treatment

Purpose: To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) drugs with a pro re nata (PRN) regimen for the treatment of choroidal neovascularization (CNV) secondary to angioid streaks (AS). Methods: This is a retrospective, multicenter, noncomparative case series of consecutive AS eyes affected by treatment-naïve CNV. A complete ophthalmologic examination was performed every 30-45 days after the loading phase, including fluorescein angiography and/or optical coherence tomography. Results: In all, 52 eyes of 39 patients were treated with intravitreal bevacizumab and/or ranibizumab and followed up for a mean of 33.8 months. The best corrected visual acuity at baseline was 20/40, and it deteriorated by an average of 6.8 ETDRS letters per year (p < 0.001). We performed an average of 5.1, 6.5, and 6.8 injections at the 1-, 2-, and 3-year follow-up, respectively. Conclusions: Intravitreal anti-VEGF drugs in a PRN regimen with close monitoring appear to slow the progression of CNV in AS, but they do not prevent the affected eyes from progressive visual loss.

Choroidal neovascularization in angioid streaks following microincision vitrectomy surgery: a case report

BackgroundPatients with angioid streaks are prone to developing subretinal hemorrhage after ocular or head injury due to the brittleness of Bruch’s membrane. However, there have been no reports of any angioid streak patients in whom choroidal neovascularization occurred after vitrectomy surgery. We report herein a patient with angioid streaks who developed choroidal neovascularization after vitrectomy surgery for epiretinal membrane.Case presentationA 76-year-old man presented with distorted vision in his left eye, with a best corrected visual acuity of 1.2 and 0.6 in his right and left eyes, respectively. Fundus examination showed angioid streaks in both eyes and epiretinal membrane only in the left eye. The patient underwent 23-gauge three-port pars plana vitrectomy with removal of the epiretinal membrane combined with cataract surgery. Internal limiting membrane in addition to the epiretinal membrane were successfully peeled and removed, with indocyanine green dye used to visualize the internal limiting membrane. His left best corrected visual acuity improved to 0.8. An elevated lesion with retinal hemorrhage due to probable choroidal neovascularization was found between the fovea and the optic disc in the left eye at 7 weeks after surgery. Since best corrected visual acuity decreased to 0.15 and the hemorrhage expanded, posterior sub-Tenon injection of triamcinolone acetonide was performed. However, no improvement was observed. Even though intravitreal bevacizumab injection was performed a total of five times, his best corrected visual acuity remained at 0.1. Subsequently, we performed a combination treatment of a standard-fluence photodynamic therapy and intravitreal ranibizumab injection, with additional intravitreal ranibizumab injections performed 3 times after this combination treatment. Best corrected visual acuity improved to 0.5 and the size of the choroidal neovascularization markedly regressed at 4 months after the combined treatment.ConclusionDevelopment of choroidal neovascularization could possibly occur in elderly patients with angioid streaks after vitrectomy surgery. In such cases, a combination of photodynamic therapy and intravitreal ranibizumab injection may be considered for initial treatment of the choroidal neovascularization.

Traitement par injection intravitréenne de ranibizumab de néovaisseaux choroïdiens compliquant des stries angioïdes : à propos d’un cas

Angioid streaks are biomicroscopically observable manifestations that frequently lead to choroidal neovascularization. Traditional treatments used to include laser photocoagulation or photodynamic therapy. Over the past few years, anti-VEGF therapies have been used as an alternative treatment. The case of a 54-year-old patient who received anti-VEGF therapy (ranibizumab) for the treatment of choroidal neovascularization secondary to angioid streaks is reported. The patient received two injections that led to complete resolution of intraretinal fluid and reduction in lesion size. After 1 year of follow-up, the patient has presented no recurrence. This case illustrates the efficacy of intravitreal anti-VEGF therapy for choroidal neovascularization in angioid streaks. Further prospective studies on a larger number of patients should help establish the best treatment and follow-up strategies.

This issue of Acta, printed and electronic

The illustrations on the cover show adaptive optic images of photoreceptor pattern in the retina as well as infrared reflectance and high definition spectral domain optical coherence tomography images described in the letter by Massamba et al. in the electronic part of the journal. Witmer et al. in Florida review acute retinal necrosis and emphasize that in addition to retinal detachment, macular edema and ischemia, optic neuropathy is an important component. Seland et al. in Norway and several European countries found that visual impairment in Europe was <3% in prevalence and blindness ranged in prevalence from 0.5% to 2%, more in southern than northern Europe. Falk et al. in Finland report that intraocular pressure decreases by about 3 mmHg following cataract surgery and remains at this level for 4 years. Yoshino et al. in Tokyo found good and stable visual outcome with a refractive aspheric silicone multifocal intraocular lens. Heussen et al. in Germany, UK and Switzerland compared vitrectomy and scleral buckling for retinal detachment. In phakic eyes vitrectomy has more reoperations, whereas in pseudophakic eyes scleral buckling has more reoperations than vitrectomy. Velikay-Parel et al. in Austria used encircling band, laser, perfluorcarbon and silicone oil for complicated retinal detachments with proliferative vitreoretinopathy. Yeh et al. in Taiwan found that intravitreal bevacizumab treatment may reduce the need of revitrectomy for recurrent vitreous hemorrhage after diabetic retinopathy. Matri et al. in Tunisia found bevacizumab to be useful for choroidal neovascularization in angioid streaks. Mekjavic et al. in Slovenia report good results with 3 monthly bevacizumab injections followed by OCT guided continuous treatment for neovascular age-related macular degeneration. Degenring et al. in Germany attempted to translocate retinal pigment epithelium and choroid to treat neovascular AMD, with variable and disappointing results. Rojas et al. in Spain found that treatment with statin reduced choroidal damage and ischemia in hypercholesterolemic rabbits. Teuchner et al. in Austria, Hungary and USA injected brain derived neurotrophic factors and other potentially neuroprotective molecules into the vitreous cavity in rats in order to delay ganglion cell loss. Martinez-de-la-Casa et al. in Spain found that rebound and noncontact tonometry gave similar results as Goldman applanation tonometry and were similarly influenced by central corneal thickness. Wang et al. in Copehagen and China show that cyclooxygenase-2 is expressed in normal human eyes and less so in some eye tumors. Kim et al. in Korea report good outcomes with porous polyethylene orbital implants. Ganesh et al. in Oman and Sweden found that 21% of patients who had esotropia surgery in childhood later developed exotropia. Swan et al. in USA comment on this article in a letter to the editor. Theodossiadis et al. in Athens document spontaneous closure of macular holes. Following is the electronic part of this issue, which is available on http://www.actaophthalmologica.com. Resch et al. in Austria and Germany found that reduced optic nerve head bloodflow is associated with worsening visual field defect and morphological changes in the optic disc. Cause and effect is unclear. Jindal et al. in USA did not find statistically significant improvements in perimetry or multifocal visual evoked potential with acute lowering of intraocular pressure. Thaler et al. in Germany and Poland demonstrate neuroprotective effects of tempol in optic nerve crush in rats. Inoue et al. in Japan found that both refractive and diffractive multifocal intraocular lenses reduced contrast of the retinal image. Filho et al. in Brazil report that intravitreal ranibizumab reduces fluorescein leakage and macular swelling sometimes associated with panretinal photocoagulation. Chrysanthi et al. in Greece and UK measured macular pigment optical density in patients with wet and dry age-related macular degeneration. Alnawaiseh et al. in Germany and USA report that Ni++ and Ca++ channels contribute to transretinal signaling in the mouse. Brignole-Baudouin et al. in France and Italy report that omega 3 and omega 6 fatty acid supplements may improve dry eye symptoms. Gatzioufas et al. in Germany comment on the paper by Fahnehjelm et al. on corneal hysteresis and Fahnehjelm and Chen reply. Swan et al. in USA comment on the strabismus paper by Ganesh et al. in this issue. Larsen et al. Copenhagen describe myofibroma of the orbit in a 1 year old. Massamba et al. in France used adaptive optics to image macular telangiectasia, as seen on the cover of the journal. Gibson et al. in UK describe negatively results in AMD genetics. Zarnowski et al. in Poland used topical bevacizumab to prevent bleb failure following trabeculectomy. Jonas et al. in Germany and Italy used intravitreal bevacizumab successfully for perifoveal telangiectasia. I hope that you find this issue of Acta to be educational and enjoyable. Please take advantage of both the printed and electronic version of the journal. Also keep in mind that older versions of Acta Ophthalmologica are available under http://www.actaophthalmologica.com where you can read interesting publications dating back to the 1920s.

A Case of Intravitreal Bevacizumab Injection for the Treatment of Choroidal Neovascularization in Angioid Streaks

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 µm at baseline to 203 µm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.

Intravitreal Ranibizumab for Choroidal Neovascularization in Angioid Streaks

To analyze retrospectively the efficacy of intravitreal ranibizumab injections for the management of choroidal neovascularization (CNV) in patients with angioid streaks. Nonrandomized, double-center, retrospective, interventional case series. A consecutive series of patients affected with CNV associated with angioid streaks were treated with intravitreal ranibizumab injections (0.5 mg/0.05 mL). Best-corrected visual acuity, fundus photography results, optical coherence tomography (OCT) results, and fluorescein angiography results were examined before and after treatment. The primary end point was the percentage of eyes with stable or improved visual acuity at the end of follow-up. Secondary end points were the percentage of eyes with stable or decreased macular thickness on optical coherence tomography and the percentage of eyes with persistent leakage on fluorescein angiography at the last follow-up examination. Thirty-five eyes of 27 patients were treated with repeated intravitreal ranibizumab injections (mean, 5.7 injections; range, 2 to 14 injections) for a mean of 24.1 months (range, 6 to 37 months). At the end of follow-up, visual acuity was stabilized or improved in 30 (85.7%) of 35 eyes. Macular thickness had stabilized or decreased in 18 (51.5%) of 35 eyes. At the last follow-up examination, on fluorescein angiography, no further leakage was observed in 23 (65.7%) of 35 eyes. In this large series of angioid streaks-associated CNV, ranibizumab injections allowed stabilization of visual acuity. Ranibizumab seems to be a safe therapeutic option in CNV associated with angioid streaks.

Immunohistochemical findings of a Bruch’s membrane defect and active choroidal neovascularization in angioid streaks

Immunohistochemical findings of a Bruch’s membrane defect and active choroidal neovascularization in angioid streaks

Choroidal Neovascularization in Angioid Streaks and Pseudoxanthoma Elasticum: 1 Year Follow-Up

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). Case review of two patients with CNV secondary to AS treated with three IVB with a 1-year follow up. 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. 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.

Indocyanine green-mediated photothrombosis for choroidal neovascularization in angioid streaks

To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. 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. 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. 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.

A Case of Photodynamic Therapy of Juxtafoveal Choroidal Neovascularization in Angioid Streaks

Purpose: To report a case of verteporfin photodynamic therapy (PDT) for juxtafoveal choroidal neovascularization (CNV) secondary to angioid streaks. Case summary: An 54-year-old male presented with metamorphopsia of the right eye. It was diagnosed as juxtafoveal CNV secondary to angioid streaks and treated with verteporfin PDT-Best corrected visual acuity (BCVA) and macular thickness by optical coherence tomography (OCT) were measured. Over 14 month follow-up period, baseline BCVA was 0.3 and it increased to 0.4 by the final examination, while macular thickness decreased from 264 μm to 229 μm. No side effects of PDT were noted. Conclusions: Verteporfin PDT for CNV-associated with angioid streaks does not appear to significantly alter the course of the disease undergoing enlargement and disciform transformation of the neovascular process. However, we expected that the actual clinical findings improved during short term follow-up. The severity of symptoms of CNV-associated with angioid streaks in a single patient varies over time, so long-term follow-up and careful examination is needed.

Photodynamic Therapy for Choroidal Neovascularization in Angioid Streaks

Purpose: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin in the management of choroidal neovascularization (CNV) associated with angioid streaks. Case summary: Six eyes of four patients with CNV due to angioid streaks were treated with photodynamic therapy with verteporfin. Visual acuity testing, ophthalmologic examinations, photographs, and fluorescein angiograms were used to evaluate the results of PDT. Two of six eyes had subfoveal lesions, while four eyes had juxtafoveal lesions on initial examination. Conversion from a CNV to a fibrous scar lesion following PDT was observed in four eyes. Enlargement of the CNV was documented in two eyes at the final follow-up. Of a total of 6 eyes, the final best-corrected visual acuity decreased in 4 eyes and stabilized in 2 eyes. Conclusions: Photodynamic therapy can achieve short-term cessation or decrease of fluorescein leakage from chroidal neovascularization associated with angioid streaks. However, it does not alter the course of this disease, and multiple sessions are needed. Visual prognosis is poor.

Tratamiento con terapia fotodinámica en las estrías angioides

A patient had bilateral angioid streaks complicated by cicatricial degeneration in the left eye and subfoveal choroidal neovascularization in the right eye. Photodynamic therapy resulted in a favorable response with normalization of the visual acuity and angiographic resolution of the lesions. The most serious complication of angioid streaks is choroidal neovascularization. Today photodynamic therapy is an effective treatment of subfoveal choroidal neovascularization. It also appears useful in the treatment of choroidal neovascularization in angioid streaks.

Verteporfin Photodynamic Therapy of Choroidal Neovascularization in Angioid Streaks: One-Year Results of a Prospective Case Series

To report the 12-month results on the use of verteporfin photodynamic therapy (PDT) in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks. Five-center prospective case series. Patients with CNV secondary to angioid streaks who were treated with PDT were recruited and followed up at 3-month intervals for 12 months, with the addition of visits at 1.5 and 4.5 months if deemed appropriate by the investigator. Best-corrected visual acuity (BCVA) was measured at each visit after full refraction or with their current distance spectacles using Early Treatment Diabetic Retinopathy Study logarithm of the minimum angle of resolution charts. Stereoscopic fundus fluorescein angiography was used to determine baseline lesion characteristics and location. Twenty-two patients were recruited (23 eyes, 16 with subfoveal CNV and 7 with juxtafoveal; all classic no occult). Seventeen patients (77%) had angioid streaks secondary to pseudoxanthoma elasticum. In the subfoveal group, median BCVA at baseline was 49 letters (approximate Snellen equivalent, 20/100) and was 46 at 12 months (approximate Snellen equivalent, 20/125). Twelve of 16 eyes (75%) lost fewer than 8 letters, whereas 14 of 16 eyes (88%) lost fewer than 15 letters. The mean CNV greatest linear dimension (GLD) was 2520 microm at baseline. At 12 months, 7 of 16 eyes with subfoveal CNV at baseline were leaking (GLD = 3220 microm; P = 0.62). The mean number of treatments in the first 12 months was 2.9. In the juxtafoveal group, the median BCVA at baseline was 66 letters (approximate Snellen equivalent, 20/50) and was 51 letters at 12 months (approximate Snellen equivalent, 20/100). Two of 7 eyes (29%) gained 8 or more letters at the 12-month examination, whereas 4 of 7 eyes (57%) lost more than 15 letters. The mean CNV GLD at baseline was 1890 microm. At 12 months, 1 of 7 eyes with juxtafoveal CNV at baseline was leaking. Choroidal neovascularization progressed from juxtafoveal to subfoveal location during the follow-up period in 4 of 7 eyes. The mean number of treatments in the first 12 months was 3.4. No side effects were noted in either patient group. This small series suggests that treatment of CNV secondary to angioid streaks with verteporfin PDT seems to limit visual loss in most patients through the first 12 months of follow-up, particularly in those with subfoveal lesions at baseline.

Photodynamic Therapy with Verteporfin of Choroidal Neovascularization in Angioid Streaks: Conventional versus Early Retreatment

To evaluate the effectiveness of conventional photodynamic therapy with verteporfin (PDT) in a series of patients with macular choroidal neovascularization (CNV) due to angioid streaks and to compare it to the effectiveness of early PDT retreatment. This is a retrospective study of 24 eyes (22 consecutive patients) with subfoveal or juxtafoveal CNV secondary to angioid streaks treated with PDT from September 2000 through February 2003 and that completed at least the first year of follow-up. Until August 2001, retreatments were performed according to the conventional protocol for PDT every 3 months (Group 1, consisting of 11 eyes of 9 patients). After August 2001 (13 more eyes of 13 new patients), retreatments were performed earlier (every 8 weeks) when indicated (Group 2). The follow-up time ranged from 30 to 42 months and from 12 to 30 months in Groups 1 and 2. At the end of the follow-up, final best-corrected visual acuity decreased in 21 (87.5%), stabilized in 2 (8.3%), and improved in 1 (4.2%) of the total 24 eyes. In all, 19 of the 24 eyes (79.2%) had a final best-corrected visual acuity equal to or less than 20/400. There were not any statistically significant differences in final visual acuity between the two groups. In this large series of patients with macular CNV secondary to angioid streaks, the functional and the anatomic results of PDT were not satisfactory, even when retreatments were performed earlier than the conventional time of 3 months.

OUTCOME OF CHOROIDAL NEOVASCULARIZATION IN ANGIOID STREAKS AFTER PHOTODYNAMIC THERAPY

To evaluate the visual and anatomic outcomes of photodynamic therapy for choroidal neovascularization (CNV) in patients with angioid streaks. The authors retrospectively evaluated 40 consecutive patients (48 eyes) with visual acuity of 20/200 or greater who were treated at 6 referral centers for CNV associated with angioid streaks. Main outcome measures were visual acuity, greatest linear diameter of the lesion, and, in patients with nonsubfoveal CNV, distance from the foveola. Of 34 eyes with subfoveal CNV, 21 were followed up for at least 12 months (range, 5-33 months). Median visual acuity was 20/50 at baseline and 20/120 at the final examination. The 12-month estimate of the percentage of eyes with vision loss of fewer than 3 lines was 68% (95% confidence interval, 50%-85%) by using survival analysis, whereas eyes with no increase in the greatest linear diameter were 45% (95% confidence interval, 27%-62%). Fourteen eyes had extrafoveal (n = 11) or juxtafoveal (n = 3) CNV, 12 of which were followed up for at least 10 months (range, 4-36 months). Visual acuity was 20/40 or greater in all eyes with extrafoveal lesions at baseline and in 5 of 12 eyes at the last examination, when 3 cases of CNV had become subfoveal. At baseline, visual acuity was low in two eyes with juxtafoveal CNV and nearly normal in the third. It remained substantially stable at the end of follow-up (range, 10-36 months), when two lesions were subfoveal. Most of our patients had good baseline visual function and, thus, were at high risk for losing vision because of the poor prognosis of CNV in angioid streaks. Because most had no or limited vision loss after 1 year, the authors suggest that photodynamic therapy can be used to try to limit or delay visual damage caused by this aggressive disease.

Surgical Removal of Choroidal Neovascularization in Angioid Streaks

All the studies so far on surgical removal of choroidal neovascularization (CNV) in angioid streaks(AS) were conducted on a small number of cases. Therefore, a definitive evaluation of the surgical method was not available. The present study aimed to evaluate this surgical modality. We performed surgical removal of foveal CNV accompanied by AS. Eighteen eyes of seventeen patients were available for follow-up of over 12 months. Surgical indications included foveal CNV, fluorescence leakage from the CNV in late-phase fluorescein angiography, and visual acuity of 0.3 or lower. The best visual acuity was improved in 44% and unchanged in 44%. The final visual acuity was improved in 33% and unchanged in 39%. 22% had a preoperative visual acuity of 0.2 or above; and 44% and 17% achieved best and final visual acuity, respectively, of 0.2 or above. Since all cases developed atrophy of the choriocapillaris in the fovea, none of the cases were capable of fixation within atrophy. The fixation point was localized outside atrophy in 56% and fixation was poor in 44%. The diameter of postoperative atrophy of choriocapillaris was significantly greater (p < 0.05) than the preoperative CNV diameter. CNV recurred in 8 eyes(44%), 88% of which occurred within one year. Surgical removal of CNV in AS is an effective method to maintain preoperative visual acuity.

Utility of laser photocoagulation of choroidal neovascularization in angioid streaks

Purpose We evaluated the utility of laser photocoagulation of extrafoveal choroidal neovascularization (CNV) in patients with angioid streaks. Subjects and methods Eleven eyes of 10 patients with extrafoveal CNV secondary to angioid streaks that underwent direct laser photocoagulation were followed for 5 months or more. We performed an intense laser photocoagulation of the CNV area determined by fluorescein angiography. We evaluated CNV diameter, the shortest distance between CNV and the fovea, the best visual acuity, the final visual acuity, existence, period, and region of the recurrence, and changes in fundus findings. Result The logarithm of the minimum angle of resolution (log MAR) final visual acuity in 9 eyes deteriorated more than two levels. The recurrence of CNV occurred in the 11 eyes; in 9 eyes CNV expanded and involved the fovea, and in two eyes photocoagulation was performed but caused an atrophic creep and resulted in scar formation including the fovea. Conclusion Based on these results, laser photocoagulation is not good therapy for CNV in angioid streaks.

Selective occlusion of subfoveal choroidal neovascularization in angioid streaks by using a new technique of ingrowth site treatment

Purpose To evaluate the visual and angiographic effects, as well as optical coherence tomography (OCT) findings, after a new treatment—neovascular ingrowth-site photothrombosis—in patients with subfoveal choroidal neovascularization (CNV) secondary to angioid streaks. Design Prospective noncomparative small case series. Participants Five eyes of 5 patients with angioid streaks in whom fluorescein and conventional indocyanine green (ICG) angiography clearly demonstrated distinct CNV vessels supplying the subfoveal neovascular complex. Intervention All five eyes were submitted to ICG-mediated photothrombosis of the neovascular ingrowth site. This novel, laser/dye-mediated technique uses large-spot, lower-intensity 810-nm light for continuous application of laser energy to ICG concentrated in vascular lesions. Main outcome measures Visual outcome and the results of fluorescein angiography, ICG angiography, and OCT evaluation. Results Fluorescein and conventional ICG angiography were sufficient to identify the CNV ingrowth site, which was juxtafoveal in 2 and extrafoveal in 3 of the 5 eyes in this series. Obliteration of the entire neovascular lesion was achieved in all patients within the first hour after ICG-mediated photothrombosis of the CNV ingrowth site. At 1 week, the mean change in best-corrected visual acuity from baseline was +3.2 (±1.4) lines. Twelve months after treatment, visual acuity improved by 3 or more lines in all patients, and decreased leakage of fluorescein from the CNV, as well as OCT evidence of reduced or resolved retinal edema, was seen at the last follow-up visit. Major complications, such as immediate severe visual loss and retinal vessel occlusion in the early posttreatment period, were not identified in the 5 patients submitted to the procedure. Conclusions Photothrombosis of the CNV ingrowth site by using lower-intensity light to direct laser energy continuously after IV ICG infusion is a safe and effective technique for rapid induction of CNV hypoperfusion in selected patients and is associated with considerable improvement in visual acuity and partial restoration of the retinal architecture up to 12 months after treatment.

Macular translocation for subfoveal choroidal neovascularization in angioid streaks

PURPOSE: To report a case of visual improvement after macular translocation performed for a subfoveal choroidal neovascular membrane in a patient with pseudoxanthoma elasticum and angioid streaks. METHODS: The fovea was translocated inferiorly by scleral imbrication, intentional retinal detachment with a small posterior retinotomy, and partial fluid–air exchange. The choroidal neovascular membrane was photocoagulated 1 week later. RESULTS: The visual acuity of the patient improved from 20/125 to 20/40. The center of the foveal avascular zone was moved inferiorly 844 μm. The choroidal neovascular membrane was extrafoveal after translocation and was treated with laser photocoagulation. CONCLUSION: Macular translocation may be considered in the management of subfoveal choroidal neovascular membrane in patients with pseudoxanthoma elasticum and angioid streaks.

Laser photocoagulation of choroidal neovascularization in angioid streaks.

To determine if laser photocoagulation of macular choroidal neovascularization in angioid streaks may be effective in preventing severe loss of vision. Sixty-six consecutive eyes of 52 patients with extrafoveal, well-defined choroidal neovascularization secondary to angioid streaks who underwent direct laser photocoagulation were followed for 3-108 months (mean, 34.5 months; median, 20 months). Pretreatment mean visual acuity was 20/40 (range, 20/200-20/20), postlaser outcome was a visual acuity of 20/50 at 3 months, 20/50 at 6 months, 20/80 at 1 year, 20/80 at 2 years, 20/100 at 3 years, 20/125 at 4 years, 20/125 at 5 years, 20/100 at 6 years, and 20/80 at 7 years. During the first year after treatment there was a significant decrease in visual acuity (P < 0.01), but no significant change thereafter. Choroidal neovascularization recurred one or more times in 77% of the eyes, but by the final examination choroidal neovascularization had been eliminated completely in 31 eyes (47%). Fellow eyes with naturally progressed choroidal neovascularization were considered control eyes. Final visual acuity in treated eyes was definitely better than that in untreated eyes (P < 0.01). This is the largest series of eyes treated by laser photocoagulation for angioid streaks and choroidal neovascularization ever reported. Laser photocoagulation of choroidal neovascularization in angioid streaks may end the choroidal neovascularization and help stabilize visual acuity or slow down visual loss. Considering the very high frequency of recurrences (77% of the eyes studied), an intense clinical and fluorangiographic follow-up period is strongly recommended, mainly for the first 3 months after treatment.