LONG-TERM PROGNOSIS OF CHOROIDAL NEOVASCULARIZATION COMPLICATING ANGIOID STREAKS

Area of Science:

• Ophthalmology
• Retinal Diseases
• Vascular Biology

Background:

• Angioid streaks are a significant risk factor for choroidal neovascularization (CNV).
• The advent of anti-vascular endothelial growth factor (anti-VEGF) agents has changed the management of wet age-related macular degeneration and other CNV causes.
• The very long-term visual prognosis of CNV in angioid streaks, particularly in the context of pseudoxanthoma elasticum (PXE), remains incompletely understood.

Purpose of the Study:

• To evaluate the very long-term visual prognosis of choroidal neovascularization (CNV) complicating angioid streaks.
• To assess the impact of anti-vascular endothelial growth factor (anti-VEGF) therapy on visual outcomes in this patient population.
• To compare outcomes between patients with and without pseudoxanthoma elasticum (PXE) and those treated with or without photodynamic therapy (PDT).

Main Methods:

• Retrospective monocentric study analyzing patient demographics, CNV features, angioid streak-associated conditions, and therapies.
• Quantitative measurement of central retinal pigment epithelial atrophy enlargement using spectral-domain optical coherence tomography (SD-OCT) infrared images.
• Assessment of changes in best-corrected visual acuity (BCVA), number of intravitreal injections, central choroidal thickness, and central retinal thickness.

Main Results:

• Mean BCVA significantly decreased from 66 to 52 Early Treatment Diabetic Retinopathy Study (ETDRS) letters over a mean follow-up of 109 months.
• Central retinal pigment epithelial atrophy enlargement ratios varied: 201% (PXE), 110% (no PXE), 240% (PDT), and 111% (no PDT).
• Thirty-three eyes of 23 patients were included in the analysis.

Conclusions:

• The very long-term visual prognosis for CNV in angioid streaks is relatively poor, despite anti-VEGF treatment.
• Patients with PXE experienced particularly poor outcomes.
• Photodynamic therapy (PDT) should be used cautiously in managing CNV associated with angioid streaks.