Long-Term Effect of Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Injections in Choroidal Neovascularization Secondary to Angioid Streaks

Abstract

Purpose. This study aimed to evaluate the long-term effectiveness of intravitreal anti-vascular endothelial growth factor (VEGF) injections in the treatment of choroidal neovascularization (CNV) associated with angioid streaks. Methods. Multicenter retrospective cohort study, including eyes with CNV secondary to angioid streaks treated with anti-VEGF injections, were performed. Best-corrected visual acuity (BCVA) in ETDRS letters; qualitative and quantitative (foveal thickness) OCT parameters; anti-VEGF type; and number of injections were collected at baseline and at 3, 6, 12, 24, 36, 48, 60, and 72 months. Results. Thirty-nine eyes from 29 patients, 17 (58.6%) females, were included. The mean follow-up time was 69.4 ± 34.5 months. BCVA was 59.3 ± 23.3 letters at baseline and 63.7 ± 21.9 letters at 48 months. At 3 months, BCVA improved 6.9 ± 11.7 letters ( P = 0.003 ). Then, BCVA remained stable. The mean foveal thickness decreased from 343.3 ± 120.2 μm at baseline to 268.3 ± 65.4 at 48 months ( P = 0.021 ). The mean number of injections was 4.6 ± 2.1 at 12 months, decreasing to 1.7 ± 2.4 injections between 36 and 48 months ( P = 0.093 ). Conclusion. This real-world study suggests that the functional and morphologic response to anti-VEGF therapy for CNV related to angioid streaks is generally satisfactory and maintained in the long term.

Qualitative analysis by OCTA in patients with choroidal neovascularization secondary to angioid streaks as predictors of disease recurrences over time

“…The development of new CNV is the single most important cause of acute visual loss in patients with AS. 12,17 Its common occurrence in young adults of working age (50 years of age or less) is even more relevant because its high incidence of recurrence, potential for scarring and permanent visual disability may damage a patient's employment prospects, cause signi cant loss of personal revenue, disrupt the patient's family dynamics, and worsen his or her quality of life. 12,13,[18][19][20] The current study describes the long-term visual outcome, response to anti-VEGF treatment, and rate of disease recurrence over time in a group of patients with AS-CNV.…”

Angioid Streaks Remain a Challenge in Diagnosis, Management, and Treatment

“…The three main anti-VEGF agents that have been used as monotherapy for the treatment of CNV secondary to ASs are ranibizumab, aflibercept, and off-label bevacizumab [ 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 ]. Numerous studies and reports have been published describing the visual and anatomical outcomes of these three anti-VEGF agents [ 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 ,…”

“…None of these reports were randomized, double-blind trials. They were either retrospective case reports or case series with a variable number of eyes enrolled and variable follow-up [ 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 ]. Nevertheless, they all demonstrate that all three anti-VEGF agents manage to at least stabilize the visual acuity regardless of the underlying systemic cause of ASs [ 3 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , …”

En-Face Optical Coherence Tomography Is Useful for Assessing Striated Lesions in Angioid Streaks: A Case Report

“…Although angioid streaks are usually asymptomatic, choroidal neovascularization (CNV) from the striated lesions may result in severe visual loss. Anti-vascular endothelial growth factor (VEGF) vitreous injections are widely used for the treatment of CNV secondary to angioid streaks [ 1 , 2 ]. However, predicting the visual prognosis in cases with angioid streaks remains an unsolved problem.…”