Macular translocation for subfoveal choroidal neovascularization in angioid streaks

doi:10.1016/S0002-9394(00)00809-6

American Journal of Ophthalmology

Volume 131, Issue 3, March 2001, Pages 390-392

https://doi.org/10.1016/S0002-9394(00)00809-6 Get rights and content

Abstract

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.

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Other Choroidal Disorders
2017, Choroidal Disorders
Intravitreal bevacizumab for nonsubfoveal choroidal neovascularization associated with angioid streaks
2014, American Journal of Ophthalmology
Citation Excerpt :
Thus, an effective treatment for this complication would be essential. Unfortunately, even though many treatment options have been suggested, including laser photocoagulation, photodynamic therapy, and surgical excision,2–17,21,22 currently there is no general consensus concerning the most appropriate treatment. Moreover, most of the studies have especially focused on the management of subfoveal CNV, whereas the treatment of nonsubfoveal CNV related to angioid streaks has received limited attention.
To evaluate the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks.
Nonrandomized, interventional, prospective case series.
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.
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.
Intravitreal bevacizumab injection can be a beneficial approach for the management of nonsubfoveal CNV secondary to angioid streaks over a 1-year follow-up.
Angioid streaks
2012, Retina Fifth Edition
Intravitreal ranibizumab for choroidal neovascularization in angioid streaks
2010, American Journal of Ophthalmology
Citation Excerpt :
Before the era of anti-VEGF therapies, treatments for angioid streaks-associated CNV had limited success. The efficacy of laser photocoagulation,7–11 transpupillary thermotherapy,12,13 PDT with verteporfin,14–20 and macular translocation21 for the treatment of CNV has been shown to be limited. In some series, stabilization of lesions has been described, but in most cases, an irreversible decrease in acuity was observed, caused by persistence of active CNV.
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.
Pseudoxanthoma Elasticum: Genetics, Clinical Manifestations and Therapeutic Approaches
2009, Survey of Ophthalmology
Citation Excerpt :
Laser photocoagulation has been shown to halt the progression of CNVs, but a high rate of recurrence, visual loss, and central scotomas occur.77,92 Likewise, surgical procedures such as macular translocation or subfoveal CNV excision have not been successful.86,108,124 The authors were unable to identify any publications regarding the intravitreal use of triamcinolone in patients with angioid streaks.
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.
Angioid Streaks Remain a Challenge in Diagnosis, Management, and Treatment
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Brief reportsMacular translocation for subfoveal choroidal neovascularization in angioid streaks

Abstract

Surv Ophthalmol

Am J Ophthalmol

Brief reports
Macular translocation for subfoveal choroidal neovascularization in angioid streaks