Sir, Intravitreal aflibercept for choroidal neovascularisation in angioid streaksChoroidal neovascularisation (CNV) is a well-known complication of angioid streaks (AS). It affects 42-86% of patients and if untreated can result in significant vision loss. 1 Treatment options have included laser photocoagulation and photodynamic therapy; 1,2 with the advent of anti-vascular endothelial growth factor (VEGF) therapies, off-label anti-VEGF has become the treatment of choice and both bevacizumab and ranibizumab have been shown to be effective. [1][2][3] We describe the off-label use of 2 mg intravitreal aflibercept in two patients as primary treatment for AS-associated CNV (AS-CNV).
Case reportThe first is a 57-year-old woman with recent left eye (OS) distortion. Visual acuities (VA) were 20/20 right and 20/25 left. Fundoscopy showed bilateral AS and a classic CNV OS (Figures 1a and b). Fluorescein angiography (FA) and CORRESPONDENCE Figure 1 Colour fundus photographs of the first patient, whose sister was known to be affected by AS and pseudoxanthoma elasticum, show bilateral AS, OD (a) and OS (b), along with an extrafoveal greyish area of CNV, with associated subretinal haemorrhages in OS. Early-phase fundus fluorescein angiography demonstrates a well-demarcated lesion (c) with late leakage (d) in OS, compatible with a classic CNV. Spectral-domain optical coherence tomography reveals a neurosensory detachment involving the fovea (e) and a hyperreflective lesion with subretinal fluid above the retinal pigment epithelium in the cross-section through the lesion. After treatment, there was resolution of the foveal subretinal fluid (f) with scarring of the CNV (g).