1
|
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.
Collapse
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
| |
Collapse
|
2
|
Intravitreal Brolucizumab for Choroidal Neovascularization Associated to Angioid Streaks. Case Rep Ophthalmol Med 2022; 2022:3442306. [PMID: 35874928 PMCID: PMC9303153 DOI: 10.1155/2022/3442306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/02/2022] [Indexed: 11/18/2022] Open
Abstract
A 44-year-old-female with angioid streak- (AS-) associated choroidal-neovascularization (CNV) was treated with one dose of intravitreal brolucizumab (IB). At one-month, the patient's visual acuity (VA) improved from 20/120 to 20/40 with a dry macula on spectral-domain optical-coherence tomography (SD-OCT). After observation, the VA improved further to 20/32 with absence of any fluid on the SD-OCT at three months. No ocular or systemic adverse events were noted. In conclusion, intravitreal brolucizumab (IB) is an efficacious and safe therapeutic option for the management of CNV secondary to AS. Further prospective studies with a larger sample size, varied therapeutic regimens, and longer follow-up period are needed to corroborate our findings.
Collapse
|
3
|
Therapy of Pseudoxanthoma Elasticum: Current Knowledge and Future Perspectives. Biomedicines 2021; 9:biomedicines9121895. [PMID: 34944710 PMCID: PMC8698611 DOI: 10.3390/biomedicines9121895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with an estimated prevalence of between 1 per 25,000 and 56,000. Its main hallmarks are characteristic skin lesions, development of choroidal neovascularization, and early-onset arterial calcification accompanied by a severe reduction in quality-of-life. Underlying the pathology are recessively transmitted pathogenic variants of the ABCC6 gene, which results in a deficiency of ABCC6 protein. This results in reduced levels of peripheral pyrophosphate, a strong inhibitor of peripheral calcification, but also dysregulation of blood lipids. Although various treatment options have emerged during the last 20 years, many are either already outdated or not yet ready to be applied generally. Clinical physicians often are left stranded while patients suffer from the consequences of outdated therapies, or feel unrecognized by their attending doctors who may feel uncertain about using new therapeutic approaches or not even know about them. In this review, we summarize the broad spectrum of treatment options for PXE, focusing on currently available clinical options, the latest research and development, and future perspectives.
Collapse
|
4
|
Shelankova AV, Budzinskaya MV. [Anti-VEGF therapy in the treatment of neovascularization secondary to angioid streaks (a case report)]. Vestn Oftalmol 2020; 136:219-225. [PMID: 32880143 DOI: 10.17116/oftalma2020136042219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents a clinical case of using anti-VEGF therapy in the treatment of retinal neovascularization consequent to angioid streaks (AS). Angioid streaks are linear breaks or divergences in an abnormally brittle or calcified Bruch's membrane. The development of choroidal neovascularization (CNV) due to AS is one of the most serious complications of the disease and the main cause of visual impairment, especially in active middle-aged patients. Currently, determination of the morphology and activity of CNV is done using multimodal macular imaging methods such as optical coherence tomography of the retina (OCT), optical coherence tomography angiography (OCT-A), fluorescin angiography (FA), indocyanine green angiography (ICGA) and autofluorescence. With the discovery of anti-VEGF therapy, it became possible to improve and stabilize functional results in this group of patients.
Collapse
|
5
|
Parodi MB, Cicinelli MV, Marchese A, Giuffrè C, Viola F, Staurenghi G, Varano M, Bandello F. Intravitreal aflibercept for management of choroidal neovascularization secondary to angioid streaks : The Italian EYLEA-STRIE study. Eur J Ophthalmol 2020; 31:1146-1153. [PMID: 32483995 DOI: 10.1177/1120672120928305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the effect and the safety of intravitreal aflibercept in patients affected by choroidal neovascularization secondary to angioid streaks with a long-term follow-up. METHODS Multicentre, open-label, phase IIb study (EYLEA-STRIE, EudraCT Number 2014-000986-30) involving four Italian centres (IRCCS Ospedale San Raffaele (Milano), Fondazione G.B. Bietti (Roma), Policlinico (Milano), Ospedale Luigi Sacco (Milano)). Patients with active choroidal neovascularization secondary to angioid streaks with foveal involvement were prospectively enrolled and followed for 18 months. All the patients received intravitreal 2 mg/0.05 mL aflibercept at the time of enrolment, followed by a pro-re-nata regimen for 48 weeks. Best-corrected visual acuity and central macular thickness were measured monthly. Adverse events were monitored at each visit. RESULTS Twenty-three eyes of 20 patients were analysed. Mean number of injections per patient was 4.30 ± 1.2. At week 48, the best-corrected visual acuity was 0.42 ± 0.40 LogMAR (p = 0.6 from baseline) and 18 eyes (81.8%) featured stability within 15 letters. The central macular thickness significantly reduced (p = 0.03). Eleven ocular non-serious adverse events and two serious adverse events were observed (one case of endophthalmitis and one case of acute gastritis were reported). CONCLUSION Intravitreal aflibercept represents a valid option for the management of choroidal neovascularization complicating angioid streaks. Further studies with longer follow-up and different therapeutic regimens are warranted to ascertain the best control of the disease.
Collapse
|
6
|
Grzybowski A, Kanclerz P. The Role of Steroids and NSAIDs in Prevention and Treatment of Postsurgical Cystoid Macular Edema. Curr Pharm Des 2019; 24:4896-4902. [PMID: 30727876 DOI: 10.2174/1381612825666190206104524] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth factor therapy. METHODS The PubMed and Web Of Science web platforms were used to find relevant studies using the following keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Other studies were also considered as a potential source of information when referenced in relevant articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as significant and analyzed. RESULTS Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid macular disease. CONCLUSION Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment, however, periocular and intravitreal steroids should be considered in refractory cases.
Collapse
Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | | |
Collapse
|
7
|
Sekfali R, Mimoun G, Cohen SY, Querques G, Bandello F, Sacconi R, Souied EH, Capuano V. Switching from ranibizumab to aflibercept in choroidal neovascularization secondary to angioid streaks. Eur J Ophthalmol 2019; 30:550-556. [PMID: 30880436 DOI: 10.1177/1120672119838133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the efficacy of switching from intravitreal ranibizumab to intravitreal aflibercept in choroidal neovascularization secondary to angioid streaks. DESIGN Multicenter retrospective interventional case series. METHODS Patients previously treated with intravitreal ranibizumab with at least 12-month follow-up (M12) after switching (M0) to intravitreal aflibercept. Switch to intravitreal aflibercept was decided in cases of refractory or recurrent choroidal neovascularization. Primary endpoint: Change of best-corrected visual acuity using the Early Treatment Diabetic Retinopathy Study letters. Secondary endpoints: Mean change of central macular thickness, absence of intraretinal/subretinal fluid on spectral domain optical coherence tomography and the percentage of eyes with absence of leakage on fluorescein angiography. RESULTS Fourteen eyes of 13 patients were included. Mean best-corrected visual acuity was 65.0 ± 21.03 letters at M0 and 63.5 ± 17.30 letters at M12 (p = 0.5). Secondary endpoints: Mean central macular thickness was 344 ± 194.65 µm at M0 and 268 ± 79.97 µm at M12 (p = 0.008). Absence of intraretinal/subretinal fluid was observed in 71%. Fluorescein angiography (nine eyes) showed absence of leakage in 77% (seven eyes). CONCLUSION Switching from intravitreal ranibizumab to intravitreal aflibercept represents a therapeutic option in patients with refractory or recurrent choroidal neovascularization secondary to angioid streaks.
Collapse
Affiliation(s)
- Rim Sekfali
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris-Est Créteil, Créteil, France
| | - Gérard Mimoun
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris-Est Créteil, Créteil, France.,Centre Ophtalmologique d'Imagerie de l'Ecole Militaire, Paris, France
| | - Salomon Yves Cohen
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris-Est Créteil, Créteil, France.,Centre d'imagerie et de Laser, Paris, France
| | - Giuseppe Querques
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris-Est Créteil, Créteil, France.,Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris-Est Créteil, Créteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris-Est Créteil, Créteil, France
| |
Collapse
|
8
|
|
9
|
Battaglia Parodi M, Romano F, Marchese A, Arrigo A, Llorenç V, Cicinelli MV, Bandello F, Adán A. Anti-VEGF treatment for choroidal neovascularization complicating pattern dystrophy-like deposit associated with pseudoxanthoma elasticum. Graefes Arch Clin Exp Ophthalmol 2018; 257:273-278. [DOI: 10.1007/s00417-018-4190-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022] Open
|
10
|
Arvas S, Akar S, Yolar M, Yetik H, Kizilkaya M, Ozkan S. Optical Coherence Tomography (OCT) and Angiography in Patients with Angioid Streaks. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210201200605] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To investigate the retinal and choroidal features of angioid streak by fluorescein angiography (FA), indocyanine green anigography (ICG-A) and optical coherence tomography (OCT). Methods We analysed 46 eyes of 23 patients with angioid streaks examined at our retina section between March 1998 and June 2000. Their mean age was 42.8 years (26–61 years). After a routine ophthalmological examination, OCT and simultaneous fluorescein and indocyanine green angiography (FA/ICG-A) were done. Color fundus photographs were also taken. Results A peau d'orange appearance and angioid streaks were more numerous and apparent with ICG-A than FA. In two eyes (4.3%), some streaks that were well visualized on FA were not visible on ICG-A. Twenty eyes (43.5%) had macular complications and 26 (56.5%) were normal. Occult choroidal neovascularization (CNV) was diagnosed by ICG-A. Nine eyes had occult, and 11 had classic CNV. Ruptures of Bruch's membrane were hypofluorescent in 20 (43.5%) and hyperfluorescent in 26 eyes (56.5%). Optic disc drusen were detected in both eyes of one patient (4.3%). Localized hyperreflectivity was thought to be due to calcium deposits. Conclusions Angioid streaks were visualized more clearly and in larger numbers by ICG-A than FA. However, in some cases streaks that were funduscopically and fluorescein angiogrpahically visible could not be seen by ICG-A. Occult CNV was detected by ICG-A. Some mottled areas were seen and more clearly visualized by ICG-A. Calcium deposits were observed as localized areas of hyperreflectivity on OCT. These findings indicate that fluorescein angiography, ICG-A and optical coherence tomography all provide supportive information for each other and can be used for either diagnosis or follow-up of those patients.
Collapse
Affiliation(s)
- S. Arvas
- Department of Ophthalmology, Istanbul University, Cerrahpasa School of Medicine, Istanbul - Turkey
| | - S. Akar
- Department of Ophthalmology, Istanbul University, Cerrahpasa School of Medicine, Istanbul - Turkey
| | - M. Yolar
- Department of Ophthalmology, Istanbul University, Cerrahpasa School of Medicine, Istanbul - Turkey
| | - H. Yetik
- Department of Ophthalmology, Istanbul University, Cerrahpasa School of Medicine, Istanbul - Turkey
| | - M. Kizilkaya
- Department of Ophthalmology, Istanbul University, Cerrahpasa School of Medicine, Istanbul - Turkey
| | - S. Ozkan
- Department of Ophthalmology, Istanbul University, Cerrahpasa School of Medicine, Istanbul - Turkey
| |
Collapse
|
11
|
Ranibizumab for choroidal neovascularization secondary to pseudoxanthoma elasticum: 4-year results from the PIXEL study in France. Graefes Arch Clin Exp Ophthalmol 2017; 255:1651-1660. [PMID: 28493086 PMCID: PMC5541092 DOI: 10.1007/s00417-017-3685-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 03/13/2017] [Accepted: 04/24/2017] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the long-term effectiveness and safety of ranibizumab 0.5 mg in patients with choroidal neovascularization (CNV) secondary to pseudoxanthoma elasticum (PXE) in a real-world setting. METHODS A descriptive, observational, multicenter study in a retrospective and prospective cohort was conducted in France that included patients who had received at least one injection of ranibizumab 0.5 mg during the period October 2011 to October 2014, for CNV secondary to PXE. Eligible patients were identified by review of medical records or during routine consultations. The main objectives were to describe patient characteristics, assess changes in best-corrected visual acuity [VA, Early Treatment Diabetic Retinopathy Study (ETDRS) letters] over time, the number and reasons for ranibizumab treatment and overall safety. RESULTS Of the 72 enrolled patients (98 eyes) from 23 centers, 39 (54.2%) were male and mean [±standard deviation (SD)] age was 59.6 (±8.3) years. The mean VA was 64.6 letters at the first ranibizumab injection, which was maintained at the 1-year follow-up (64.7 letters). Thereafter, the mean VA was stable until the 4-year follow-up. At 4 years, the proportion of eyes with VA gain of ≥15 letters was 3/19 (15.8%) and stable VA (change between -15 and +15 letters) was 10/19 (52.6%). Mean (±SD) annual number of ranibizumab injections was 4.1 (±4.0), lower in the second versus first year. The most common reason for ranibizumab treatment was progression of neovascular activity (42.9%). No deaths or new safety findings were reported. CONCLUSIONS In patients with CNV secondary to PXE, ranibizumab 0.5 mg resulted in stable VA over 4 years with a limited number of injections. Safety findings were consistent with the established safety profile of ranibizumab.
Collapse
|
12
|
Martinez-Serrano MG, Rodriguez-Reyes A, Guerrero-Naranjo JL, Salcedo-Villanueva G, Fromow-Guerra J, García-Aguirre G, Morales-Canton V, Velez-Montoya R. Long-term follow-up of patients with choroidal neovascularization due to angioid streaks. Clin Ophthalmol 2016; 11:23-30. [PMID: 28031699 PMCID: PMC5182034 DOI: 10.2147/opth.s118016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The following case series describes the long-term anatomical and functional outcome of a group of seven patients with choroidal neovascularization (CNV), secondary to angioid streaks (AS), who were treated with antiangiogenic drugs in a pro re nata (PRN) regimen. After the 4-year mark, visual acuity tends to return to pretreatment level. Treatment delays and lack of awareness and self-referral by the patients are believed to be the cause of the PRN regimen failure. Purpose To assess the long-term outcomes (>4 years) of patients with CNV due to AS treated with a PRN regimen of antiangiogenic. Methods This was a retrospective, case series, single-center study. We reviewed the electronic medical records from patients with CNV due to AS. From each record, we noted general demographic data and relevant medical history; clinical presentation, changes in best-corrected visual acuity (BCVA) over time, optical coherent tomography parameters, treatment and retreatment details, and systemic associations. Changes in BCVA and central macular thickness were assessed with a Wilcoxon two-sample test, with an alpha value of ≤0.05 for statistical significance. Results The mean follow-up time was 53.8±26.8 months. BCVA at baseline was: 1.001±0.62 logMAR; at the end of follow-up: 0.996±0.56 logMAR (P=0.9). Central macular thickness at baseline was: 360.85±173.82 μm; at the end of follow-up: 323.85±100.34 μm (P=0.6). Mean number of intravitreal angiogenic drugs: 6±4.16 injections (range 4–15). Mean time between injections was 3.8±2.7 months (range 1.9–5.8 months). Conclusion Despite initial anatomical and functional improvement, patients at the end of the follow-up had no visual improvement after a pro re nata regimen of antiangiogenic drugs. The amount of retreatments, number of recurrences, and time between intravitreal injections were similar to previous reports with shorter follow-up.
Collapse
Affiliation(s)
| | - Abelardo Rodriguez-Reyes
- Pathology Department, Asociación para Evitar la Ceguera en Mexico, Hospital "Dr Luis Sanchez Bulnes" IAP
| | | | | | | | | | | | | |
Collapse
|
13
|
Tan ACS, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. Clinical Application of Multicolor Imaging Technology. Ophthalmologica 2016; 236:8-18. [PMID: 27404384 DOI: 10.1159/000446857] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/12/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the clinical application of multicolor imaging by confocal scanning laser ophthalmoscopy (cSLO). METHODS Retinal imaging was performed in 76 patients including cSLO multicolor imaging (SPECTRALIS SD-OCT, Heidelberg Engineering, Heidelberg, Germany) and color fundus photography (CFP). RESULTS The use of confocal optics, reduced light scatter and automated eye tracking enable high-resolution cSLO reflectance images. Compared to CFP, the appearance of pigment alterations and hemorrhages were some of the differences observed. Various artifacts including those derived from optical media alterations need to be considered when interpreting images. Specific pathological findings including epiretinal membranes, fibrovascular proliferations, and reticular pseudodrusen may be better visualized on multicolor images. CONCLUSIONS When using multicolor imaging, ophthalmologists need to be mindful about differences in the appearance of pathological changes and artifacts. Multicolor imaging may offer information over and above conventional CFP; it can be performed through undilated pupils and is less affected by media opacities.
Collapse
Affiliation(s)
- Anna C S Tan
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | | |
Collapse
|
14
|
Iacono P, Battaglia Parodi M, La Spina C, Bandello F. Intravitreal Bevacizumab for Nonsubfoveal Choroidal Neovascularization Associated With Angioid Streaks: 3-Year Follow-up Study. Am J Ophthalmol 2016; 165:174-8. [PMID: 27013066 DOI: 10.1016/j.ajo.2016.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks (AS) in a 3-year follow-up study. DESIGN Noncomparative, interventional, prospective case series. METHODS Eighteen patients (18 eyes) with juxtafoveal/extrafoveal CNV secondary to AS were recruited. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on ETDRS chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections on the basis of detection of new hemorrhage, any type of fluid on OCT, and/or presence of FA leakage. Primary outcome measures were final mean changes in BCVA and proportion of eyes with 10 ETDRS letters improvement. Secondary outcomes were mean changes of central macular thickness (CMT) and foveal involvement. RESULTS After a mean BCVA stabilization over the first year, a statistically significant BCVA worsening was registered at the 24-month (72.8 ± 10.0 ETDRS letters, P = .03) and 36-month examinations (65.8 ± 15.0 ETDRS letters, P = .02) in comparison with the 1-year visual outcomes (80.1 ± 5.4 ETDRS letters); lastly, a substantial stabilization in the BCVA was observed at 36 months in comparison with the baseline value (77.9 ± 10.0 ETDRS letters, P = .22). Two eyes (25%) with juxtafoveal CNV and no eye with extrafoveal CNV experienced a 10-letter improvement at the 3-year examination. Mean CMT at baseline was 220 ± 15 μm and 235 ± 66 μm at 36 months (P = 1.00). During the first and second years of follow-up, 5 juxtafoveal CNVs and 3 extrafoveal CNVs showed foveal involvement. CONCLUSIONS Intravitreal bevacizumab can be effective in the management of nonsubfoveal CNV secondary to AS, although monthly monitoring is required to control CNV recurrence or progression.
Collapse
Affiliation(s)
- Pierluigi Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy.
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo La Spina
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
15
|
|
16
|
INTRAVITREAL BEVACIZUMAB IN THE TREATMENT OF CHOROIDAL NEOVASCULAR MEMBRANE DUE TO ANGIOID STREAKS. Retina 2015; 35:2001-10. [DOI: 10.1097/iae.0000000000000605] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
17
|
Battaglia Parodi M, Iacono P, La Spina C, Berchicci L, Scotti F, Leys A, Introini U, Bandello F. Intravitreal bevacizumab for nonsubfoveal choroidal neovascularization associated with angioid streaks. Am J Ophthalmol 2014; 157:374-377.e2. [PMID: 24211865 DOI: 10.1016/j.ajo.2013.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks. DESIGN Nonrandomized, interventional, prospective case series. METHODS Fifteen patients (15 eyes) affected by juxtafoveal or extrafoveal CNV secondary to angioid streaks were enrolled in the study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on Early Treatment Diabetic Retinopathy Study (ETDRS) chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections over a 12-month follow-up period on the basis of the detection of new hemorrhage on biomicroscopic examination, any type of fluid on OCT, or presence of leakage on FA. PRIMARY OUTCOME MEASURES Mean changes in BCVA and proportion of eyes gaining at least 10 letters (2 ETDRS lines) at the end of the follow-up. SECONDARY OUTCOMES Mean changes of central macular thickness (CMT) and extension to the fovea. RESULTS Mean BCVA did not change throughout the follow-up period, being 0.2 ± 0.2 logMAR at baseline and 0.2 ± 0.3 logMAR at the 12-month examination. A functional improvement of at least 2 ETDRS lines was achieved by 5 eyes (33%), with 3 eyes (20%) gaining 3 lines. Mean CMT at baseline was 215 ± 13 μm and 225 ± 85 μm at the 12-month examination. Two eyes (13.3%) showed CNV extension to the fovea. CONCLUSIONS Intravitreal bevacizumab injection can be a beneficial approach for the management of nonsubfoveal CNV secondary to angioid streaks over a 1-year follow-up.
Collapse
|
18
|
Abstract
PURPOSE To evaluate different therapies for choroidal neovascularization (CNV) due to angioid streaks (AS). METHODS Studies were identified by a systematic literature search and were included in the analysis based on predefined criteria. Primary outcome measure was change in best-corrected visual acuity (BCVA). RESULTS Fifty-four relevant studies were identified and included mostly uncontrolled case series. No randomized controlled trials were available. Treatment with vascular endothelial growth factor inhibitors improved or stabilized BCVA in all case series. Photodynamic therapy slowed down disease progression with stabilization or decrease of BCVA. Individual BCVA and follow-up data for each treated eye were reported in >160 cases for both treatments, vascular endothelial growth factor inhibitors and photodynamic therapy. In a pooled analysis of those studies, the difference of mean change in BCVA between both treatment groups was estimated as approximately 6 lines (0.59 logMAR [95% confidence interval, 0.38-0.8; P < 0.0001]). A better baseline BCVA was associated with a better BCVA outcome (P < 0.0001). Laser photocoagulation yielded comparable results as photodynamic therapy but application was mostly restricted to extrafoveal lesions, was complicated by frequent recurrences, and led to more retinal damage with subsequent absolute scotomas. Combination therapies seem to be not superior to monotherapy. CONCLUSION Intravitreal vascular endothelial growth factor inhibitors are currently the most effective treatment of CNV due to angioid streaks.
Collapse
|
19
|
Nagpal M, Bhardwaj S. Choroidal neovascularization in a case of angioid streaks. Indian J Ophthalmol 2013; 61:665-6. [PMID: 24008786 PMCID: PMC3959085 DOI: 10.4103/0301-4738.116454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manish Nagpal
- Vitreoretinal Consultant, Department of Vitreoretina,Retina Foundation, Ahmedabad, Gujarat, India
| | | |
Collapse
|
20
|
Wolff B, Sahel JA, Mateo-Montoya A, Mauget-Faÿsse M, Baillif S, Le Mer Y. Traitement par injection intravitréenne de ranibizumab de néovaisseaux choroïdiens compliquant des stries angioïdes : à propos d’un cas. J Fr Ophtalmol 2013; 36:e5-9. [DOI: 10.1016/j.jfo.2012.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 03/15/2012] [Indexed: 11/24/2022]
|
21
|
Lam LA. Angioid Streaks. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Matonti F, Conrath J. [Angioid streaks]. J Fr Ophtalmol 2012; 35:838-45. [PMID: 23046745 DOI: 10.1016/j.jfo.2012.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/10/2012] [Indexed: 10/27/2022]
Abstract
Angioid streaks represent breaks in Bruch's membrane, appearing as dark or reddish radial streaks eminating from the optic disc. Usually asymptomatic, these streaks may develop neovascularisation and lead to a maculopathy with marked loss of vision. Some associations with systemic disease are classically described, especially pseudoxanthoma elasticum. This condition may involve cardiovascular complications. A mutation has been found in the ABCC6 gene, which encodes for a membrane transport protein involved in the synthesis of the extracellular matrix. Imaging allows for visualization of the extent of the streaks, and autofluorescence is particularly informative. Spectral domain OCT may also demonstrate early breaks in Bruch's membrane. Neovascular complications, previously responsible for inevitable visual impairment at some point after their occurrence, are now managed by intravitreal injections of anti-VEGFs with clear efficacity. The ophthalmologist must be aware of this condition, in order to guide the patient towards a systemic work-up if necessary, and also to insure quick and targeted treatment in the case of neovascular complications.
Collapse
Affiliation(s)
- F Matonti
- Service d'ophtalmologie, hôpital Nord, chemin des Bourrelys, 13015 Marseille, France
| | | |
Collapse
|
23
|
Shah M, Amoaku WMK. Intravitreal ranibizumab for the treatment of choroidal neovascularisation secondary to angioid streaks. Eye (Lond) 2012; 26:1194-8. [PMID: 22722486 DOI: 10.1038/eye.2012.116] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To assess the medium to long-term efficacy and safety of intravitreal ranibizumab for the treatment of choroidal neovascularisation (CNV) secondary to angioid streaks (AS). METHODS A total of 12 eyes of nine patients treated with intravitreal ranibizumab (0.5 mg in 0.05 ml) for CNV secondary to AS were retrospectively identified. Efficacy of treatment was determined by changes in best-corrected LogMAR visual acuity (BCVA) and optical coherence tomography. Changes with respect to baseline BCVA were defined as improved or reduced with a gain or loss of more than 10 letters, respectively, or stable if remaining within 10 letters. RESULTS Over a mean follow-up of 21.75 months (range: 1-54), patients received mean 5.75 (range: 2-15) intravitreal ranibizumab injections per affected eye. BCVA improved in three eyes (25%), stabilised in eight eyes (66.67%), and deteriorated in one eye (8.33%). There was no significant change in central retinal thickness (CRT) over the follow-up period (P=0.1072). No drug-related systemic side effects were recorded. CONCLUSION The long-term treatment of CNV secondary to AS with intravitreal ranibizumab showed a stabilisation in CRT and an improvement or stabilisation of BCVA. The absence of systemic side effects was reassuring. Further long-term prospective studies are required to validate these findings.
Collapse
Affiliation(s)
- M Shah
- Division of Ophthalmology and Visual Sciences, Eye and ENT Centre, University Hospital, Queen's Medical Centre, Nottingham, UK
| | | |
Collapse
|
24
|
Finger RP, Charbel Issa P, Hendig D, Scholl HP, Holz FG. Monthly ranibizumab for choroidal neovascularizations secondary to angioid streaks in pseudoxanthoma elasticum: a one-year prospective study. Am J Ophthalmol 2011; 152:695-703. [PMID: 21704964 DOI: 10.1016/j.ajo.2011.03.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of monthly intravitreal ranibizumab for the treatment of choroidal neovascularizations (CNV) secondary to angioid streaks (AS) in pseudoxanthoma elasticum (PXE). DESIGN Twelve-month prospective, open-label, uncontrolled, nonrandomized interventional clinical trial. METHODS In 7 patients, 1 eye with an active CNV was injected with 0.5 mg ranibizumab monthly over 1 year. Distance and reading visual acuity, reading speed, angiographic findings, and central retinal thickness (CRT) on optical coherence tomography were assessed at each visit. Central retinal light increment sensitivity (LIS) was assessed by microperimetry at baseline, at 6 months, and 3 to 4 months after the last injection. RESULTS Best-corrected visual acuity increased significantly from baseline to month 12 (20/63 or 61 ETDRS letters to 20/32 or 73 ETDRS letters; P = .012). The effect was maintained 3 months later (61 ETDRS letters to 72 ETDRS letters; P = .055). Reading acuity and speed could be maintained throughout the study. Central LIS improved (6.6 dB, SD ± 5.9 at baseline to 7.4 dB, SD ± 6.2 at last follow-up; P < .001). Leakage from active CNVs subsided. Mean change in CRT from baseline to month 12 and 15 was -86 μm (P = .074) and -65 μm (P = .182), respectively. No serious adverse events occurred. CONCLUSIONS Efficacy outcomes indicate a beneficial therapeutic effect of intravitreal ranibizumab on central visual function including retinal LIS. Both the functional and morphologic response based on angiographic and OCT findings to ranibizumab treatment implicate an important pathophysiological role of vascular endothelial growth factor in CNVs secondary to AS in PXE. Intravitreal ranibizumab appears to be a safe and efficacious treatment in these patients.
Collapse
|
25
|
Cekiç O, Göçmez E, Kocabora MS. Management of CNV in angioid streaks by intravitreal use of specific anti-VEGF165 Aptamer (pegaptanib sodium): long-term results. Curr Eye Res 2011; 36:492-5. [PMID: 21501082 DOI: 10.3109/02713683.2011.560409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the effectiveness of intravitreal pegaptanib sodium injection in patients with choroidal neovascularization (CNV) secondary to angioid streaks. METHODS Five eyes of four patients with angioid streaks with CNV underwent uneventful intravitreal injection of pegaptanib sodium (0.3 mg/90 µL). Patients were followed up with Snellen visual acuity testing, optical coherence tomography, and fundus fluorescein angiography. RESULTS The median follow-up time was 18 months (range: 15 to 24 months). Visual acuity improved in two eyes, and stabilized in three out of five eyes. At final examination, CNV regressed with resolution of subretinal fluid in all but one patient with bilateral CNV from angioid streaks. CONCLUSION Intravitreal pegaptanib sodium for CNV associated with angioid streaks led to inactivation of most of the CNV lesions, stabilizing or improving visual acuity in all eyes.
Collapse
Affiliation(s)
- Osman Cekiç
- Department of Ophthalmology, Vakıf Gureba Training and Research Hospital, İstanbul, Turkey.
| | | | | |
Collapse
|
26
|
Lee JW, Shin JP, Kim SY. A case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in angioid streaks. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:218-21. [PMID: 21655051 PMCID: PMC3102829 DOI: 10.3341/kjo.2011.25.3.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 12/12/2009] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ji Woong Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | | | | |
Collapse
|
27
|
Váradi A, Szabó Z, Pomozi V, de Boussac H, Fülöp K, Arányi T. ABCC6 as a target in pseudoxanthoma elasticum. Curr Drug Targets 2011; 12:671-82. [PMID: 21039331 PMCID: PMC3324121 DOI: 10.2174/138945011795378612] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 05/10/2010] [Indexed: 01/30/2023]
Abstract
The ABCC6 gene encodes an organic anion transporter protein, ABCC6/MRP6. Mutations in the gene cause a rare, recessive genetic disease, pseudoxanthoma elasticum, while the loss of one ABCC6 allele is a genetic risk factor in coronary artery disease. We review here the information available on gene structure, evolution as well as the present knowledge on its transcriptional regulation. We give a detailed description of the characteristics of the protein, and analyze the relationship between the distributions of missense disease-causing mutations in the predicted three-dimensional structure of the transporter, which suggests functional importance of the domain-domain interactions. Though neither the physiological function of the protein nor its role in the pathobiology of the diseases are known, a current hypothesis that ABCC6 may be involved in the efflux of one form of Vitamin K from the liver is discussed. Finally, we analyze potential strategies how the gene can be targeted on the transcriptional level to increase protein expression in order to compensate for reduced activity. In addition, pharmacologic correction of trafficking-defect mutants or suppression of stop codon mutations as potential future therapeutic interventions are also reviewed.
Collapse
Affiliation(s)
- András Váradi
- Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary.
| | | | | | | | | | | |
Collapse
|
28
|
Nika M, Besirli CG. Choroidal neovascularization and angioid streaks in pseudoxanthoma elasticum. Int J Ophthalmol 2011; 4:449-51. [PMID: 22553699 DOI: 10.3980/j.issn.2222-3959.2011.04.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 05/12/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To report a case of pseudoxanthoma elasticum (PXE) in a 48 year old woman that presented with bilateral blurry vision. METHODS A case report RESULTS A 48-year-old woman presented with bilateral blurry vision and right eye metamorphopsia. The patient had a history of angioid streaks in the left eye ten years ago for which she had received laser surgery and had poor residual vision. Visual acuity was 20/60 in the right eye and count fingers at 6 feet in the left. Fundus examination showed subretinal hemorrhage and macular thickening on the right and a disciform macular scar with focal atrophic pigment epithelial lesions on the left. Both eyes had angioid streaks and peau d'orange pigmentary pattern of the retina. External examination showed several, yellow skin papules and plaques on the lateral and posterior neck, as well as prominent mental creases. Pathologic examination of skin biopsy confirmed the diagnosis of PXE, showing calcium deposition and fragmented, clumped elastic fibers in the deep reticular dermis. She responded well to intravitreal bevacizumab injections and visual acuity improved to 20/25 OD. Preventative care was emphasized and the patient was referred to cardiology, gastroenterology and human genetics for counseling. CONCLUSION PXE is a multisystem disorder affecting the dermatologic, ocular, and cardiovascular systems. Ophthalmic findings of angioid streaks and choroidal neovascularization in the presence of stereotypical skin changes and prominent mental creases should prompt evaluation for PXE.
Collapse
Affiliation(s)
- Melisa Nika
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | | |
Collapse
|
29
|
Georgalas I, Tservakis I, Papaconstaninou D, Kardara M, Koutsandrea C, Ladas I. Pseudoxanthoma elasticum, ocular manifestations, complications and treatment. Clin Exp Optom 2010; 94:169-80. [PMID: 21198842 DOI: 10.1111/j.1444-0938.2010.00559.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Pseudoxanthoma elasticum (PXE), also known as Groenblad syndrome, is an inherited disorder characterised by mineralisation and fragmentation of elastic fibres in a number of organs including the skin, eyes and arterial blood vessels. The clinical manifestations of PXE centre on three major organ systems: skin, cardiovascular system and the eyes. This review focuses on the ocular manifestations of pseudoxanthoma elasticum, namely, peau d'orange, angioid streaks and choroidal neovascularisation, the clinical course of patients, the diagnostic approaches and current therapeutic strategies, such as laser photocoagulation whether transpupillary thermotherapy or photodynamic therapy, macular translocation surgery and anti-vascular endothelial growth factor treatment.
Collapse
Affiliation(s)
- Ilias Georgalas
- Department of Ophthalmology, G Gennimatas Hospital of Athens, NHS, University of Athens, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
30
|
Mimoun G, Tilleul J, Leys A, Coscas G, Soubrane G, Souied EH. Intravitreal ranibizumab for choroidal neovascularization in angioid streaks. Am J Ophthalmol 2010; 150:692-700.e1. [PMID: 20719301 DOI: 10.1016/j.ajo.2010.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 05/30/2010] [Accepted: 06/02/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze retrospectively the efficacy of intravitreal ranibizumab injections for the management of choroidal neovascularization (CNV) in patients with angioid streaks. DESIGN Nonrandomized, double-center, retrospective, interventional case series. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Gerard Mimoun
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, University of Paris XII Henri Mondor, France
| | | | | | | | | | | |
Collapse
|
31
|
INTRAVITREAL RANIBIZUMAB TREATMENT OF MACULAR CHOROIDAL NEOVASCULARIZATION SECONDARY TO ANGIOID STREAKS. Retina 2010; 30:1185-9. [DOI: 10.1097/iae.0b013e3181d2f11d] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Pece A, Russo G, Ricci F, Isola V, Introini U, Querques G. Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks. Clin Ophthalmol 2010; 4:525-30. [PMID: 20596507 PMCID: PMC2893762 DOI: 10.2147/opth.s10649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report the visual outcome of photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA) for choroidal neovascularization (CNV) secondary to angioid streaks (AS). METHODS Five eyes of five consecutive patients (mean age 45 +/- 10 years) with CNV secondary to AS were treated by combination of PDT and IVTA. TA (4 mg/0.1 mL) was injected 7 days before PDT. RESULTS All patients completed the 12-month follow-up. CNV was subfoveal in three cases and extrafoveal in two. Median best-corrected visual acuity (BCVA) was 0.3 LogMAR (70 letters) at baseline (range 1.3-0.1), and 0.5 LogMAR (60 letters) at the final examination (range 1.0-0.1). At 12 months, one patient had severe visual deterioration, with a loss of seven lines of VA; Two patients lost up to three lines. One patient had no change in BCVA and the fifth gained nine lines of VA. Two patients received one further combination of PDT and IVTA after the first combination treatment. All eyes showed the CNV closure at the 12-month follow-up visit. CONCLUSIONS Combination of PDT and IVTA may reduce the need for retreatment and could be potentially useful for preserving vision in some patients with CNV due to AS.
Collapse
Affiliation(s)
- Alfredo Pece
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
33
|
|
34
|
LONG-TERM OUTCOMES OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION IN PSEUDOXANTHOMA ELASTICUM. Retina 2010; 30:748-55. [DOI: 10.1097/iae.0b013e3181c596b1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
35
|
Sawa M, Gomi F, Tsujikawa M, Sakaguchi H, Tano Y. Long-term results of intravitreal bevacizumab injection for choroidal neovascularization secondary to angioid streaks. Am J Ophthalmol 2009; 148:584-590.e2. [PMID: 19541288 DOI: 10.1016/j.ajo.2009.04.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 04/27/2009] [Accepted: 04/27/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the long-term efficacy of intravitreal injections of bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) for choroidal neovascularization (CNV) secondary to angioid streaks. DESIGN Observational case series. METHODS Fifteen eyes of 13 patients (5 men, 8 women; mean age, 59 years; range, 54 to 70 years) treated with 1-mg intravitreal bevacizumab injections were included. The minimum follow-up after the first injection was 12 months. Eyes that had undergone previous treatments were excluded. The best-corrected visual acuity (BCVA) was measured. Optical coherence tomography and fluorescein angiography images were examined before and after treatment. RESULTS The mean follow-up was 19 months (range, 12 to 24 months). The mean number of injections for primary CNV was 4.5 (range, 1 to 9). The mean preoperative BCVA (decimal equivalent) was 0.39 (range, 0.08 to 1.5) and 0.47 (range, 0.06 to 1.2) at the final visit (P = .355). The BCVA improved by 2 lines of logarithm of the minimum angle of resolution visual acuity at the final visit in 5 eyes (33%), was unchanged in 8 eyes (54%), and decreased in 2 eyes (13%). The final fluorescein angiography examination showed no leakage in 10 eyes (67%), minimal leakage in 2 eyes (13%), and persistent or recurrent leakage in 3 eyes (20%). Five eyes (33%) had a recurrence 4 to 7 months (mean, 5.1 months) after the last bevacizumab injection. New CNV lesions developed in different areas in 3 eyes (20%) 6 to 14 months after the last bevacizumab injection for primary CNV. CONCLUSIONS An intravitreal injection of bevacizumab seems to maintain visual acuity. However, CNV frequently recurred or new CNV developed during the long follow-up.
Collapse
Affiliation(s)
- Miki Sawa
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.
| | | | | | | | | |
Collapse
|
36
|
Finger RP, Charbel Issa P, Ladewig MS, Götting C, Szliska C, Scholl HPN, Holz FG. Pseudoxanthoma elasticum: genetics, clinical manifestations and therapeutic approaches. Surv Ophthalmol 2009; 54:272-85. [PMID: 19298904 DOI: 10.1016/j.survophthal.2008.12.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pseudoxanthoma elasticum (PXE) is an inherited disorder that is associated with accumulation of mineralized and fragmented elastic fibers in the skin, vascular walls, and Bruch's membrane in the eye. Clinically, patients exhibit characteristic lesions of the posterior segment of the eye including peau d'orange, angioid streaks, and choroidal neovascularisations, of the skin including soft, ivory-colored papules in a reticular pattern that predominantly affect the neck and large flexor surfaces, and of the cardiovascular system with peripheral and coronary arterial occlusive disease as well as gastrointestinal bleedings. There is yet no definitive therapy. Recent studies suggest that PXE is inherited almost exclusively as an autosomal recessive trait. Its prevalence has been estimated to be 1:25,000-100,000. Very recently, the ABCC6 gene on chromosome 16p13.1 was found to be associated with the disease. Mutations within ABCC6 cause reduced or absent transmembraneous transport that leads to accumulation of extracellular material. Presumably, this mechanism causes calcification of elastic fibers. Despite the characteristic clinical features, the variability in phenotypic expressions, and the low prevalence may be responsible for the disease being underdiagnosed. This review compiles and summarizes current knowledge of PXE pathogenesis and clinical findings. Furthermore, different therapeutic strategies to treat retinal manifestations are discussed, including thermal laser coagulation, photodynamic therapy, and intravitreal injections of drugs inhibiting vascular endothelial growth factor.
Collapse
Affiliation(s)
- Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
A number of retinal disorders may present with fleck-like lesions in the retina. We describe the case of a 13-year-old girl who presented with a complaint of decreased vision and prior diagnosis of "fleck-retina." Further examination revealed that the patient had an autosomal recessive disorder associated with systemic manifestations. In the current article, the authors describe the case report and briefly review the various autosomal-recessive disorders that may present with "retinal flecks."
Collapse
Affiliation(s)
- Saloni Walia
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois 60612-7234, USA
| | | | | |
Collapse
|
38
|
Wecke T, Knop C, Schreiber W, Behrens-Baumann W. Intraokulare Bevacizumab-Injektionen bei seltenen Indikationen – zwei Kasuistiken. Ophthalmologe 2008; 106:435-42. [DOI: 10.1007/s00347-008-1782-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Bock A, Schwegler G. Intracerebral haemorrhage as first manifestation of Pseudoxanthoma elasticum. Clin Neurol Neurosurg 2008; 110:262-4. [DOI: 10.1016/j.clineuro.2007.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Revised: 09/09/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
|
40
|
Garcia RA, Jablon EP, Oria V, Rodriguez-Fontal M, Alfaro DV, Parikh NS. Functional and anatomical outcomes for intravitreal bevacizumab treatment of choroidal neovascularization in a patient with angioid streaks. Retin Cases Brief Rep 2008; 2:136-140. [PMID: 25389825 DOI: 10.1097/icb.0b013e31814cee22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To evaluate the visual and anatomical outcomes of intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) treatment of choroidal neovascularization (CNV) in patients with angioid streaks (ASs). METHODS A 44-year-old man with angioid streaks and CNV in both eyes (best-corrected visual acuity: 20/400, right eye; 20/50, left eye) received intravitreal bevacizumab injections at monthly intervals. RESULTS Best-corrected visual acuity in the right eye after 2 intravitreal injections of bevacizumab was 20/70 and remained the same at the 6-month follow-up. Best-corrected visual acuity in the left eye after 3 intravitreal injections of bevacizumab was 20/25 and remained the same at the 9-month follow-up. CONCLUSIONS After intravitreal administration of bevacizumab, our patient had visual acuity improvement in both eyes that was associated with rapid and significant reduction in thickness, subretinal fluid, and size of subfoveal neovascularization secondary to ASs. Intravitreal bevacizumab treatment resulted in a meaningful and sustained vision gain after the 9-months follow-up.
Collapse
Affiliation(s)
- Reinaldo A Garcia
- From the Retina Consultants of Charleston, Charleston, South Carolina
| | | | | | | | | | | |
Collapse
|
41
|
Lee JM, Nam WH, Kim HK. Photodynamic therapy with verteporfin for choroidal neovascularization in patients with angioid streaks. KOREAN JOURNAL OF OPHTHALMOLOGY 2007; 21:142-5. [PMID: 17804918 PMCID: PMC2629678 DOI: 10.3341/kjo.2007.21.3.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks. Methods The authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size. Results Their mean age was 61.3±5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5±10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400±766.81 µm, and the mean GLD at the last examination was 3483±444.59 µm. Conclusions PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.
Collapse
Affiliation(s)
- Jun Mok Lee
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | | | | |
Collapse
|
42
|
Bhatnagar P, Freund KB, Spaide RF, Klancnik JM, Cooney MJ, Ho I, Fine HF, Yannuzzi LA. INTRAVITREAL BEVACIZUMAB FOR THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION IN PSEUDOXANTHOMA ELASTICUM. Retina 2007; 27:897-902. [PMID: 17891014 DOI: 10.1097/iae.0b013e31809ff5df] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine the results of intravitreal bevacizumab injections for the management of choroidal neovascularization (CNV) in patients with pseudoxanthoma elasticum (PXE)-associated angioid streaks. METHODS A consecutive series of patients with PXE and CNV were managed with intravitreal bevacizumab injection (1.25 mg per 0.05 cc). The main outcome measures were visual acuity and greatest lesion height as measured by optical coherence tomography (OCT). RESULTS Nine eyes of nine consecutive patients received intravitreal bevacizumab (1.25 mg/0.05 mL) injections. The mean follow-up time was 6 months, during which eyes received an average of 1.8 injections. The baseline visual acuity was a mean of 20/368 and improved to 20/289 at the last visit (P = 0.056). Visual acuity either improved or stabilized in all 9 eyes (100%). Serial OCT measurements in 8 eyes showed a mean of 353 microm at baseline, which decreased to 201 mum at the last visit (P = 0.012). No complications were noted. CONCLUSIONS These short-term results support the use of intravitreal bevacizumab for the management of CNV in patients with PXE. Continued experience with intravitreal bevacizumab in this population will help establish its longer-term efficacy and better define the potential need for serial injections to maintain these results.
Collapse
Affiliation(s)
- Pawan Bhatnagar
- LuEsther T. Mertz Retina Research Center of the Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Jurklies B, Bornfeld N, Schilling H. Photodynamic Therapy Using Verteporfin for Choroidal Neovascularization Associated with Angioid Streaks – Long-Term Effects. Ophthalmic Res 2006; 38:209-17. [PMID: 16679809 DOI: 10.1159/000093071] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 05/18/2005] [Indexed: 11/19/2022]
Abstract
AIM To investigate the safety and efficacy of photodynamic therapy with verteporfin (PDT) in patients with choroidal neovascularization associated with angioid streaks (CNVAS). METHODS A nonrandomized, prospective clinical investigation of 12 patients with CNVAS was performed. PDT was based on the criteria concerning the treatment of age-related macular degeneration. RESULTS The mean follow-up was 41.75 months (range 24-60). The mean number of (re)treatments was 3.3 (range 2-7). Visual acuity improved by at least 1 line in 42%, was stable within +/-2 lines in 33%, decreased by at least 1 line in 58% and by >3 lines in 25% of the patients. The mean visual acuity was 0.30 (range 0.2-0.5) prior to and 0.17 (range 0.03-0.6) after the final PDT. The mean visual acuity of the contralateral eye was 0.1. 75% of contralateral eyes and 25% of the treated eyes had a final visual acuity of < or =0.1 (20/200). At the final follow-up, a significant enlargement of the lesion size was noted in 92% of the cases. CONCLUSION Using the current (re)treatment criteria, PDT does not appear to limit the growth of CNVAS. Compared to the aggressive natural course and to the limited treatment options, PDT may at least in part help to stabilize macular function over a limited period of time.
Collapse
Affiliation(s)
- Bernhard Jurklies
- Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, DE-45122 Essen, Germany.
| | | | | |
Collapse
|
44
|
Ladewig MS, Götting C, Szliska C, Issa PC, Helb HM, Bedenicki I, Scholl HPN, Holz FG. Pseudoxanthoma elasticum. Ophthalmologe 2006; 103:537-51; quiz 552-3. [PMID: 16763870 DOI: 10.1007/s00347-006-1353-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pseudoxanthoma elasticum (PXE) is an inherited disorder that is associated with accumulation of mineralized and fragmented elastic fibers in the skin, vessel walls, and Bruch's membrane. Clinically, patients exhibit characteristic lesions of the skin (soft, ivory-colored papules in a reticular pattern that predominantly affect the neck), the posterior segment of the eye (peau d'orange, angioid streaks, choroidal neovascularizations), and the cardiovascular system (peripheral arterial occlusive disease, coronary occlusion, gastrointestinal bleeding). There is no causal therapy. Recent studies suggest that PXE is inherited almost exclusively as an autosomal recessive trait. Its prevalence has been estimated to be 1:25,000-100,000. The ABCC6 gene on chromosome 16p13.1 is associated with the disease. Mutations within the ABCC6 gene cause reduced or absent transmembraneous transport that leads to accumulation of substrate and calcification of elastic fibers. Although based on clinical features the diagnosis appears readily possible, variability in phenotypic expressions and the low prevalence may be responsible that the disease is underdiagnosed. This review covers current knowledge of PXE and presents therapeutic approaches.
Collapse
Affiliation(s)
- M S Ladewig
- Universitäts-Augenklinik, Ernst-Abbe-Strasse 2, 53105 Bonn.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Choroidal neovascularization (CNV) is a common cause of vision loss in patients <50 years of age. In these patients, CNV is often the result of pathologic myopia, ocular histoplasmosis syndrome, angioid streaks, or idiopathic causes. Rarely, CNV is seen in children, usually in association with inherited macular dystrophies such as Best's disease (vitelliform macular dystrophy) or drusen of the optic nerve. This article discusses the role of optometrists in the detection and management of CNV. Untreated CNV can cause rapid deterioration of central vision and is associated with a poor prognosis. Optometrists may be able to improve the prognosis of younger patients with CNV by recognizing the signs, symptoms, and risk factors for CNV and promptly referring patients with suspected CNV to a retina specialist. They can also help patients by providing long-term support and rehabilitation. Recent treatment advances, such as the availability of verteporfin (Visudyne; Novartis Pharma AG, Basel, Switzerland) therapy, that are applicable to younger patients with CNV have increased the importance of early detection of CNV and prompt referral of patients to a specialist who can treat CNV.
Collapse
Affiliation(s)
- David G Miller
- Retina Associates of Cleveland, Inc., Cleveland, Ohio 44122, USA.
| | | |
Collapse
|
46
|
Arias L, Pujol O, Rubio M, Caminal J. Long-term results of photodynamic therapy for the treatment of choroidal neovascularization secondary to angioid streaks. Graefes Arch Clin Exp Ophthalmol 2005; 244:753-7. [PMID: 16228218 DOI: 10.1007/s00417-005-0131-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 08/08/2005] [Accepted: 08/10/2005] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the anatomic-functional results and complications associated with the use of photodynamic therapy (PDT) with verteporfin in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks (AS). METHODS The authors retrospectively evaluated 10 consecutive patients (10 eyes) with CNV secondary to AS. All patients were treated with standard PDT with verteporfin protocol. The primary outcome to evaluate was the proportion of cases that lost < 3 lines of visual acuity (VA) measured on ETDRS charts. Secondary outcomes were changes in the greatest linear dimension (GLD) and in the area of the lesion. Seven previously examined patients were used as a control group. RESULTS The mean duration of follow-up was 18 months (SD 9.2, range 6-36 months). In nine cases CNV was subfoveal and in one case, juxtafoveal. Mean VA was 20/126 at baseline (range 20/40-20/320) and 20/500 at the final examination (range 20/64-20/800). Three patients (30%) lost< 3 lines of VA. Four patients (40%) lost > or =6 lines of VA. The mean line change was -4.9 lines. The mean GLD went from 2861 microm at baseline (SD 1086.6, range 1350-4300 microm) to 4452 microm at last visit (SD 2564.2, range 1260-9450 microm). The mean area of the lesion was 3.78 mm(2) at baseline (SD 1.9, range 1.0-5.7 mm(2)) and 12.1 mm(2) at the final examination (SD 15.1, range 0.8-50.6 mm(2)). One patient developed a subfoveal rip of the retinal pigment epithelium. In the control group, the mean duration of follow-up was 15 months (SD 2.4, range 12-18 months). At baseline, the mean VA was 20/160 (range 20/100-20/320) and the mean GLD was 2685 microm (SD 676.8, range 1800-3500 microm). At the last examination, mean VA was 20/640 (range: 20/400-20/800) and mean GLD was 5528 microm (SD 2106.90, range 3500-8000 microm). CONCLUSION PDT with verteporfin does not seem to be a good treatment for stabilization of VA and lesion size in CNV secondary to AS, although the overall results seem to be slightly better in the group of patients treated with PDT than in the control group.
Collapse
Affiliation(s)
- Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital (L'Hospitalet de Llobregat), C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | | | | | | |
Collapse
|
47
|
Browning AC, Chung AKK, Ghanchi F, Harding SP, Musadiq M, Talks SJ, Yang YC, Amoaku WM. Verteporfin photodynamic therapy of choroidal neovascularization in angioid streaks: one-year results of a prospective case series. Ophthalmology 2005; 112:1227-31. [PMID: 15921757 DOI: 10.1016/j.ophtha.2005.02.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 02/07/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE 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. STUDY DESIGN Five-center prospective case series. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Andrew C Browning
- Division of Ophthalmology and Visual Sciences, Eye, Ear, Nose and Throat Centre, University Hospital, Queen's Medical Centre, Nottingham, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Heimann H, Gelisken F, Wachtlin J, Wehner A, Völker M, Foerster MH, Bartz-Schmidt KU. Photodynamic therapy with verteporfin for choroidal neovascularisation associated with angioid streaks. Graefes Arch Clin Exp Ophthalmol 2005; 243:1115-23. [PMID: 15947939 DOI: 10.1007/s00417-005-1193-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 02/24/2005] [Accepted: 02/25/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Choroidal neovascularizations (CNV) is the major cause of significant visual loss in patients with angioid streaks. We evaluated the functional and morphological outcome of Verteporfin photodynamic therapy (PDT) in the treatment of these patients. METHODS This was a retrospective study in two tertiary referral centres over a 3-year period. Examinations included visual acuity assessment with ETDRS charts, binocular fundoscopy and fluorescein angiography. PDT was performed with standard parameters; earlier retreatments were feasible in active CNV. RESULTS Fifteen eyes from 12 patients (9 male, 3 female) with a follow-up of 12-50 months (mean 26.1, median 19 months) were included. Five lesions were extra-or juxtafoveal and ten were subfoveal. Baseline visual acuity was between 20/63 and 20/16 (mean 20/32, median 20/32). Eyes were treated with two to eight treatments of PDT (mean 4.2, median 4). Treatment intervals were between 5.6 and 72 weeks (mean 12.1, median 9.2 weeks). At the 1-year follow-up, visual acuity was below 20/200 in 27% (4/15), 20/200 or better in 73% (11/15) and 20/63 or better in 47% (7/15) with an improvement of >3 lines in 13% (2/15), no change in 27% (4/15) and a decrease of >3 lines in 60% (9/15). At the final follow-up examination, all lesions were located subfoveally. Visual acuity was below 20/200 in 47% (7/15), 20/200 or better in 53% (8/15) and 20/63 or better in 13% (2/15) with a change in visual acuity between +2 and -18 lines (mean -9 lines, median -8 lines). No change was noted in 7% (1/15) and a decrease of >3 lines in 93% (14/15) of eyes. The maximum measured greatest linear dimension of the lesion during the follow-up varied between 2400 microm and 6200 microm (mean 3680 microm, median 3600 microm) with an increase in the lesion size compared with baseline values between +/-0 microm and +3700 microm (mean+1420 microm, median+1500 microm). CONCLUSION PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss. Further modifications of the treatments parameters or a combination with other therapeutical options seem warranted for a more effective treatment of these lesions.
Collapse
Affiliation(s)
- Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | | | | | | | | | | | | |
Collapse
|
49
|
Chung AKK, Gauba V, Ghanchi FD. Photodynamic therapy (PDT) using verteporfin for juxtafoveal choroidal neovascularisation (CNV) in angioid streaks (AS) associated with pseudoxanthoma elasticum: 40 months results. Eye (Lond) 2005; 20:629-31. [PMID: 15920567 DOI: 10.1038/sj.eye.6701930] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
50
|
Menchini U, Virgili G, Introini U, Bandello F, Ambesi-Impiombato M, Pece A, Parodi MB, Giacomelli G, Capobianco B, Varano M, Brancato R. OUTCOME OF CHOROIDAL NEOVASCULARIZATION IN ANGIOID STREAKS AFTER PHOTODYNAMIC THERAPY. Retina 2004; 24:763-71. [PMID: 15492632 DOI: 10.1097/00006982-200410000-00013] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the visual and anatomic outcomes of photodynamic therapy for choroidal neovascularization (CNV) in patients with angioid streaks. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Ugo Menchini
- Department of Oto-Neuro-Ophthalmological Surgical Sciences, University of Florence, Florence, Italy, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|