Laser photocoagulation of choroidal neovascularization in angioid streaks

To determine if laser photocoagulation of macular choroidal neovascularization in angioid streaks may be effective in preventing severe loss of vision.

Sixty-six consecutive eyes of 52 patients with extrafoveal, well-defined choroidal neovascularization secondary to angioid streaks who underwent direct laser photocoagulation were followed for 3-108 months (mean, 34.5 months; median, 20 months).

Pretreatment mean visual acuity was 20/40 (range, 20/200-20/20), postlaser outcome was a visual acuity of 20/50 at 3 months, 20/50 at 6 months, 20/80 at 1 year, 20/80 at 2 years, 20/100 at 3 years, 20/125 at 4 years, 20/125 at 5 years, 20/100 at 6 years, and 20/80 at 7 years. During the first year after treatment there was a significant decrease in visual acuity (P < 0.01), but no significant change thereafter. Choroidal neovascularization recurred one or more times in 77% of the eyes, but by the final examination choroidal neovascularization had been eliminated completely in 31 eyes (47%). Fellow eyes with naturally progressed choroidal neovascularization were considered control eyes. Final visual acuity in treated eyes was definitely better than that in untreated eyes (P < 0.01).

This is the largest series of eyes treated by laser photocoagulation for angioid streaks and choroidal neovascularization ever reported. Laser photocoagulation of choroidal neovascularization in angioid streaks may end the choroidal neovascularization and help stabilize visual acuity or slow down visual loss. Considering the very high frequency of recurrences (77% of the eyes studied), an intense clinical and fluorangiographic follow-up period is strongly recommended, mainly for the first 3 months after treatment.