Long-term follow-up of patients with choroidal neovascularization due to angioid streaks

Abstract

BackgroundThe following case series describes the long-term anatomical and functional outcome of a group of seven patients with choroidal neovascularization (CNV), secondary to angioid streaks (AS), who were treated with antiangiogenic drugs in a pro re nata (PRN) regimen. After the 4-year mark, visual acuity tends to return to pretreatment level. Treatment delays and lack of awareness and self-referral by the patients are believed to be the cause of the PRN regimen failure.PurposeTo assess the long-term outcomes (>4 years) of patients with CNV due to AS treated with a PRN regimen of antiangiogenic.MethodsThis was a retrospective, case series, single-center study. We reviewed the electronic medical records from patients with CNV due to AS. From each record, we noted general demographic data and relevant medical history; clinical presentation, changes in best-corrected visual acuity (BCVA) over time, optical coherent tomography parameters, treatment and retreatment details, and systemic associations. Changes in BCVA and central macular thickness were assessed with a Wilcoxon two-sample test, with an alpha value of ≤0.05 for statistical significance.ResultsThe mean follow-up time was 53.8±26.8 months. BCVA at baseline was: 1.001±0.62 logMAR; at the end of follow-up: 0.996±0.56 logMAR (P=0.9). Central macular thickness at baseline was: 360.85±173.82 μm; at the end of follow-up: 323.85±100.34 μm (P=0.6). Mean number of intravitreal angiogenic drugs: 6±4.16 injections (range 4–15). Mean time between injections was 3.8±2.7 months (range 1.9–5.8 months).ConclusionDespite initial anatomical and functional improvement, patients at the end of the follow-up had no visual improvement after a pro re nata regimen of antiangiogenic drugs. The amount of retreatments, number of recurrences, and time between intravitreal injections were similar to previous reports with shorter follow-up.

Long-Term Follow-Up of Choroidal Neovascularization due to Angioid Streaks with pro re nata Intravitreal Anti-VEGF Treatment

“…These data are partially in agreement with those obtained by Battaglia Parodi et al [41] , which showed a substantial stability of functional outcomes. Similar results after a longer follow-up were reported by Martinez-Serrano et al [45] in 14 eyes. In contrast, our data disagree with the data obtained by Sawa et al [31] , Finger et al [34] , El Matri et al [35] , Mimoun et al [24] , Ladas et al [37] , and Shah et al [40] , who demonstrated a trend for improvement or stability of functional and anatomical outcomes in their case series.…”

“…Anti-VEGF intravitreal injections were found to be effective, obtaining good anatomical and functional results, but there is no agreement on the appropriate dosing strategy (PRN, treat and extend, or fixed) [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] . Furthermore, long-term data have not yet been published, except for a little sample recently reported on by Martinez-Serrano et al [45] . Our study presents the largest retrospective case series reported to date concerning the treatment of CNV secondary to AS using intravitreal bevacizumab and/or ranibizumab.…”

“…We think that a treat-and-extend protocol may allow better visual and anatomical results, but it imposes a higher burden of intravitreal treatments on patients. Explaining these differences in results is difficult, but we think that the different selection criteria for cases (naïve/not naïve, extra/juxta/subfoveal CNV), different durations of follow-up, and different treatment regimens used (PRN protocol [24,31,34,35,40,45] , single injection followed by a PRN protocol [41] , and treat-and-extend protocol [37] ) certainly played an important role. In fact, our results show a strong tendency towards relapse and confirm the difficulties in controlling a disease that deteriorates in the long term despite a close follow-up, especially in the case of subfoveal CNV and in eyes with a low baseline visual acuity.…”

“…It was also shown that combination therapies do not yield better results than monotherapy [28,[42][43][44] . At present, in chronically active AS-related CNV, the available treatments do not prevent the functional loss but rather limit it [23,45] . In this context, an analysis of long-term functional and anatomical outcomes is helpful to corroborate these findings.…”

Angioid streaks in pseudoxanthoma elasticum

“…They may occur in isolation or with systemic diseases like pseudoxanthoma elasticum (PXE),1 Ehlers-Danlos syndrome, Paget’s disease and haemoglobinopathies. Visual symptoms occur only when the lesions involve the fovea or cause secondary complications like choroidal neovascularisation (CNV) 2. This case describes clinical signs of AS in a patient who was subsequently diagnosed with PXE.…”