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Rohart C, Le HM, Estrada-Walker J, Giocanti-Auregan A, Cohen SY. LONG-TERM PROGNOSIS OF CHOROIDAL NEOVASCULARIZATION COMPLICATING ANGIOID STREAKS. Retina 2023; 43:882-887. [PMID: 36727798 DOI: 10.1097/iae.0000000000003746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To report the very long-term visual prognosis of choroidal neovascularization complicating angioid streaks in the antivascular endothelial growth factor era. METHODS Retrospective monocentric study aimed at analyzing patients' demographics, choroidal neovascularization features, angioid streak-associated conditions, and previous and current therapies for choroidal neovascularization. The main outcome measures were the quantitative measurement of central retinal pigment epithelial atrophy enlargement by comparing the ratio of pixels involved on automated infrared images acquired by spectral-domain optical coherence tomography and the changes in best-corrected visual acuity. The secondary outcome measures were the number of intravitreal injections and the changes in central choroidal thickness and central retinal thickness. Subgroup analyzes were performed to compare macular atrophy extent between eyes of patients with or without proven pseudoxanthoma elasticum ("PXE" or "no PXE") and between eyes previously treated or not with photodynamic therapy ("PDT" or "no PDT"). RESULTS Thirty-three eyes of 23 patients were included. The mean best-corrected visual acuity decreased significantly from 66 ± 19 Early Treatment Diabetic Retinopathy Study letters at the time of the first antivascular endothelial growth factor injection to 52 ± 23 Early Treatment Diabetic Retinopathy Study letters at the end of the follow-up (mean follow-up duration: 109 ± 42 months, range: 47-175 months). The ratio of central retinal pigment epithelial atrophy enlargement was 201%, 110%, 240%, and 111% in the PXE, no PXE, PDT, and no PDT groups, respectively. CONCLUSION Despite the use of antivascular endothelial growth factor agents, the very long-term prognosis appeared relatively poor, especially in patients with PXE. This study also suggests that PDT should be used with caution in the management of choroidal neovascularization in eyes with angioid streaks.
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Affiliation(s)
- Charlotte Rohart
- Ophthalmology Center for Imaging and Laser, Paris
- Department of Ophthalmology, Ophtalmopôle Hôpital Cochin, APHP, and University of Paris, Paris, France
- Department of Ophthalmology, Clinique Beausoleil, Montpellier, France
| | - Hoang-Mai Le
- Department of Ophthalmology, University of Paris-Est Creteil, France; and
| | | | | | - Salomon Y Cohen
- Ophthalmology Center for Imaging and Laser, Paris
- Department of Ophthalmology, University of Paris-Est Creteil, France; and
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Cicinelli MV, Torrioli E, La Franca L, Agrawal H, Barthelmes D, Chhablani J, Chowers I, Foa N, Goldstein M, Mansour A, Muhammed RP, Sivaprasad S, Vilela MAP, Zweifel S, Bandello F, Battaglia Parodi M. Incidence and Risk Factors of Visual Impairment in Patients with Angioid Streaks and Macular Neovascularization. Ophthalmol Retina 2022; 7:431-440. [PMID: 36503161 DOI: 10.1016/j.oret.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and risk factors of visual impairment and complications in eyes with macular neovascularization (MNV) because of angioid streaks (ASs). DESIGN Longitudinal multicenter retrospective cohort study. SUBJECTS Patients with AS-associated MNV treated with anti-VEGF agents and a follow-up of > 3 months. METHODS Clinical and MNV characteristics were collected at baseline. Visual acuity (VA) values and the presence of atrophy or fibrosis were collected at each visit. MAIN OUTCOME MEASURES Rate of VA change over time and associated factors; the incidence rate of moderate-to-severe visual impairment (MSVI) and blindness and hazard ratio (HR) of candidate risk factors for MSVI; the incidence rate of fibrosis and macular atrophy. RESULTS Overall, 84 eyes of 66 patients (39 men, 58%) with a mean (standard deviation) age of 55.7 (13.8) years were followed for a mean (standard deviation) of 67.7 (48.5) months. The median number of anti-VEGF doses per eye was 13. The average rate (95% confidence interval [CI]) of visual loss was +0.04 (0.02-0.06) logarithm of the minimum angle of resolution/year (P < 0.001); the visual loss was faster in nonnaive eyes (P = 0.007) and those with better baseline VA (P < 0.001); it was slower in eyes with pattern dystrophy-like features (P = 0.04). The incidence rates (95% CI) of MSVI and blindness were 10.4 (6.88-15)/100-eye-years and 2.33 (1.12-4.29)/100-eye-years. A higher number of injections (HR [95% CI] = 0.45 [0.19-0.94] for receiving ≥ 13 injections vs. < 13; P = 0.03) was protective against MSVI. The incidence rates (95% CI) of fibrosis and macular atrophy were 24.1 (17.5-32.3)/100-eye-years and 14.3 (10.1-19.6)/100-eye-years. CONCLUSIONS Eyes with MNV-related AS had a high rate of visual impairment and propensity to macular fibrosis and atrophy. A higher number of injections yielded better chances of maintaining good VA, suggesting the need for intensive treatment. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Edoardo Torrioli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lamberto La Franca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hitesh Agrawal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Itay Chowers
- Hadassah Medical Center, and the Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Michaella Goldstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Manuel A P Vilela
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Battaglia Parodi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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