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To laser or not?

Vishal Govindhari1, Jay Chhablani1

  • 1Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India.

Indian Journal of Ophthalmology
|February 27, 2018
PubMed
Summary
This summary is machine-generated.

Focal thermal laser treatment for choroidal neovascularization (CNVM) in angioid streaks may worsen Bruch's membrane integrity. This can lead to CNVM exacerbation, necessitating alternative treatments like intravitreal ziv-aflibercept injections.

Keywords:
Angioid streakschoroidal neovascular membranefocal laseroptical coherence tomography angiographyziv-aflibercept

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Area of Science:

  • Ophthalmology
  • Retinal Diseases

Background:

  • Angioid streaks are a known risk factor for choroidal neovascularization (CNVM).
  • Management of CNVM in the context of angioid streaks presents unique challenges.

Observation:

  • A patient with angioid streaks developed CNVM in the left eye, initially treated with focal thermal laser.
  • Initial regression of CNVM was observed post-laser, but exacerbation occurred at 3-month follow-up.

Findings:

  • Focal thermal laser treatment appeared to worsen breaks in Bruch's membrane.
  • This worsening of Bruch's membrane integrity led to exacerbation of the CNVM.
  • Intravitreal ziv-aflibercept injections were subsequently administered, leading to CNVM scarring.

Implications:

  • Thermal laser photocoagulation may be detrimental in eyes with angioid streaks.
  • Alternative treatments, such as anti-vascular endothelial growth factor (anti-VEGF) therapy, should be considered for CNVM in this patient population.
  • Understanding the impact of treatment on Bruch's membrane is crucial for managing angioid streaks and associated CNVM.