Angioid Streaks Follow-up

  • Author: Mohammad Abusamak, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Sep 22, 2011
 

Further Outpatient Care

  • Screening and follow-up examination by means of Amsler grid and ophthalmoscopic examination, including FA, may be necessary to detect CNVM and to treat recurrences.
  • Patients who undergo laser treatment or surgery need close follow-up care during the first 3 months of treatment. If they stay asymptomatic and no FA leakage occurs, follow-up care every 6 months is recommended.
Next

Complications

  • Subretinal hemorrhage and serous detachment are common complications of angioid streaks. Incidence of subretinal hemorrhage and serous detachment caused by choroidal neovascularization is high, about 85% of all patients with PXE and 10-15% of patients with Paget disease of the bone. The disease is bilateral in all patients with an average age of onset older than 25 years.
Previous
Next

Prognosis

  • A high risk of serious complications, such subretinal hemorrhage and serous detachment, exists. Bilateral involvement is the rule, although it may not be symmetrical. Families with affected individuals need screening and regular eye examinations for early detection of any progression.
Previous
Next

Patient Education

  • Patients should be instructed to return if visual acuity decreases. Signs of decreased central visual acuity may include central blurred vision, difficulty in depth perception, and distortion of lines and objects.
  • Families and patients will benefit from using an Amsler grid to detect early changes in asymptomatic but high-risk individuals.
  • More emphasis should be placed on safety measures to avoid trauma even if trivial. Protective goggles are useful for young patients who participate in sports.
Previous
 
Contributor Information and Disclosures
Author

Mohammad Abusamak, MD  Chief of Retina Division, Jordan University Hospital; Assistant Professor, Division of Ophthalmology, University of Jordan Faculty of Medicine; Ophthalmologist, Amman Eye Clinic, Jordan

Mohammad Abusamak, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell P Jayne, MD  Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Doyne RW. Choroidal and retinal changes. The result of blows on the eyes. Trans Ophthal. 1889;9:128.

  2. Knapp H. On the formation of dark angioid streaks as an unusual metamorphosis of retinal hemorrhage. Arch Ophthalmol. 1892;21:289-292.

  3. Klien BA. Angioid Streaks: A clinical and histopathologic study. American Journal of Ophthalmology. 1947;30:955-68.

  4. Abujamra S, Negretto AD, Saraceno JJ, Oliveira TL, Gomes AM. [Angioid streaks: fundoscopic analysis of 317 cases]. Arq Bras Oftalmol. Nov-Dec 2008;71(6):819-21. [Medline].

  5. Mansour AM, Ansari NH, Shields JA, Annesley WH Jr, Cronin CM, Stock EL. Evolution of angioid streaks. Ophthalmologica. 1993;207(2):57-61. [Medline].

  6. Dhermy P. Histologie Angioid Streaks. In: Cosca G, Soubane G, eds. Neovasseaux Sous-Retiniens et Laser. Paris, France: 1987:210-1.

  7. Gass J, Donald M. Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment. Vol. 1. 4th ed. CV Mosby: 1997:120.

  8. Piro PA, Scheraga D, Fine S. Angioid Streaks: Natural history and visual prognosis. In: Management of Retinal Vascular and Macular Disorders. Williams and Wilkins; 1983:136-9.

  9. Clarkson JG, Altman RD. Angioid streaks. Surv Ophthalmol. Mar-Apr 1982;26(5):235-46. [Medline].

  10. Karacorlu M, Karacorlu S, Ozdemir H, et al. Photodynamic therapy with verteporfin for choroidal neovascularization in patients with angioid streaks. Am J Ophthalmol. Sep 2002;134(3):360-6. [Medline].

  11. Sawa M, Gomi F, Tsujikawa M, Sakaguchi H, Tano Y. Long-term results of intravitreal bevacizumab injection for choroidal neovascularization secondary to angioid streaks. Am J Ophthalmol. Oct 2009;148(4):584-590.e2. [Medline].

  12. Neri P, Salvolini S, Mariotti C, Mercanti L, Celani S, Giovannini A. Long-term control of choroidal neovascularisation secondary to angioid streaks treated with intravitreal bevacizumab (Avastin). Br J Ophthalmol. Feb 2009;93(2):155-8. [Medline].

  13. Finger RP, Charbel Issa P, Hendig D, Scholl HP, Holz FG. Monthly Ranibizumab for Choroidal Neovascularizations Secondary to Angioid Streaks in Pseudoxanthoma Elasticum: A One-Year Prospective Study. Am J Ophthalmol. Jun 24 2011;[Medline].

  14. Prabhu VV, Morris RJ, Shah PK, Narendran V. Combination treatment of low fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane secondary to angioid streaks in Paget's disease - 12 month results. Indian J Ophthalmol. Jul-Aug 2011;59(4):306-8. [Medline]. [Full Text].

  15. Artunay O, Yuzbasioglu E, Rasier R, Sengul A, Senel A, Bahcecioglu H. Combination treatment with intravitreal injection of ranibizumab and reduced-fluence photodynamic therapy for choroidal neovascularization secondary to angioid streaks: Preliminary Clinical Results of 12-Month Follow-Up. Retina. Jul-Aug 2011;31(7):1279-86. [Medline].

  16. Eckstein M, Wells JA, Aylward B, Gregor Z, et al. Surgical removal of non-age-related subfoveal choroidal neovascular membranes. Eye. 1998;12 (Pt 5):775-80. [Medline].

  17. Adelung JC. Zur Geneseder angioid streaks (Knapp). Klin Monatsbl Augenheilkd. 1951;119:241.

  18. Aveline B, Hasan T, Redmond RW. Photophysical and photosensitizing properties of benzoporphyrin derivative monoacid ring A (BPD-MA). Photochem Photobiol. Mar 1994;59(3):328-35. [Medline].

  19. Bock J. Zur Klinik und Anatomic der gefaessehnlichen Streifen in Augenhintergrund. Z Augenheilkd. 1938;95:1-50.

  20. Eretto P, Krohel GB, Shihab ZM, et al. Optic neuropathy in Paget's disease. Am J Ophthalmol. Apr 1984;97(4):505-10. [Medline].

  21. Francois J, De Laey JJ, Cambie E, et al. Neovascularization after argon laser photocoagulation of macular lesions. Am J Ophthalmol. Feb 1975;79(2):206-10. [Medline].

  22. Gelisken O, Hendrikse F, Deutman AF. A long-term follow-up study of laser coagulation of neovascular membranes in angioid streaks. Am J Ophthalmol. Mar 15 1988;105(3):299-303. [Medline].

  23. Guyer DR, Gragoudas ES, D'Amico DJ. Chapter 66: Angioid Streaks. In: Principles and Practice of Ophthalmology. Vol. 2. 1993:852-60.

  24. Hagedoorn A. Angioid streaks. Arch Ophthalmol. 1939;21:746-74.

  25. Heimann H, Gelisken F, Wachtlin J, et al. Photodynamic therapy with verteporfin for choroidal neovascularization associated with angioid streaks. Graefes Arch Clin Exp Ophthalmol. Nov 2005;243(11):1115-23. [Medline].

  26. Ladas ID, Georgalas I, Rouvas AA, et al. Photodynamic therapy with verteporfin of choroidal neovascularization in angioid streaks: conventional versus early retreatment. Eur J Ophthalmol. Jan-Feb 2005;15(1):69-73. [Medline].

  27. Lafaut BA, Leys AM, Scassellati-Sforzolini B, et al. Comparison of fluorescein and indocyanine green angiography in angioid streaks. Graefes Arch Clin Exp Ophthalmol. May 1998;236(5):346-53. [Medline].

  28. Macular Photocoagulation Study. Persistent and recurrent neovascularization after krypton laser photocoagulation for neovascular lesions of age-related macular degeneration. Macular Photocoagulation Study Group. Arch Ophthalmol. Jun 1990;108(6):825-31. [Medline].

  29. Macular Photocoagulation Study Group. Persistent and recurrent neovascularization after krypton laser photocoagulation for neovascular lesions of ocular histoplasmosis. Macular Photocoagulation Study Group. Arch Ophthalmol. Mar 1989;107(3):344-52. [Medline].

  30. Meislik J, Neldner K, Reeve EB, et al. Laser treatment in maculopathy of pseudoxanthoma elasticum. Can J Ophthalmol. Jul 1978;13(3):210-12. [Medline].

  31. Miller H, Miller B, Ryan SJ. Correlation of choroidal subretinal neovascularization with fluorescein angiography. Am J Ophthalmol. Mar 15 1985;99(3):263-71. [Medline].

  32. Pece A, Avanza P, Introini U, et al. Indocyanine green angiography in angioid streaks. Acta Ophthalmol Scand. Jun 1997;75(3):261-5. [Medline].

  33. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials--TAP report. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group. Arch Ophthalmol. Oct 1999;117(10):1329-45. [Medline].

  34. Pierro L, Brancato R, Minicucci M, et al. Echographic diagnosis of Drusen of the optic nerve head in patients with angioid streaks. Ophthalmologica. 1994;208(5):239-42. [Medline].

  35. Reinke MH, Canakis C, Husain D, et al. Verteporfin photodynamic therapy retreatment of normal retina and choroid in the cynomolgus monkey. Ophthalmology. Oct 1999;106(10):1915-23. [Medline].

  36. Schmidt-Erfurth U, Hasan T, Gragoudas E, et al. Vascular targeting in photodynamic occlusion of subretinal vessels. Ophthalmology. Dec 1994;101(12):1953-61. [Medline].

  37. Scott LJ, Goa KL. Verteporfin. Drugs Aging. Feb 2000;16(2):139-46; discussion 147-8. [Medline].

  38. Shields JA, Federman JL, Tomer TL, Annesley WH Jr. Angioid streaks. I. Ophthalmoscopic variations and diagnostic problems. Br J Ophthalmol. May 1975;59(5):257-66. [Medline].

  39. Sickenberg M, Schmidt-Erfurth U, Miller JW, et al. A preliminary study of photodynamic therapy using verteporfin for choroidal neovascularization in pathologic myopia, ocular histoplasmosis syndrome, angioid streaks, and idiopathic causes. Arch Ophthalmol. Mar 2000;118(3):327-36. [Medline].

  40. Singerman LJ, Hatem G. Laser treatment of choroidal neovascular membranes in angioid streaks. Retina. 1981;1(2):75-83. [Medline].

  41. Walker ER, Frederickson RG, Mayes MD. The mineralization of elastic fibers and alterations of extracellular matrix in pseudoxanthoma elasticum. Ultrastructure, immunocytochemistry, and X-ray analysis. Arch Dermatol. Jan 1989;125(1):70-6. [Medline].

 
Previous
Next
 
Progression of angioid streaks. Large subretinal hemorrhage.
Same eye as in previous image, 11 months later. Partial resolution of subretinal blood. Notice the old subretinal hemorrhage under the fovea and color change to white-yellow.
Late complication of choroidal neovascularization in angioid streaks. Same eye as in previous images, 5 years later. Notice the extensive scarring and subretinal exudates and dehemoglobinized blood.
Red-free photograph of the optic nerve and posterior pole showing the cracks in the Bruch membrane. Notice the retinal arteries and veins crossing over the dark red streaks.
Early fluorescein angiography showing the early hyperfluorescence, window defect, of the angioid streaks.
Late fluorescein angiography of the same eye as in Media file 2. Notice the staining of the edges of the streaks. Also, staining in the center of the macula is present due to extension of the Bruch membrane crack. When compared to early fluorescein angiography, no active leakage is present.
Right eye, midphase arteriovenous, showing choriocapillaris atrophic changes. This 45-year-old patient underwent 3 injections of Avastin and one session of half-time photodynamic therapy.
Same patient as in previous image, a few months before the Avastin injection and half-time photodynamic therapy.
A 50-year-old man with a 2-month history of blurring vision in the left eye. The color photograph showed subretinal blood and large membrane, extrafoveal in location.
Early fundus fluorescein angiography showing the hyperfluorescence of the choroidal neovascular membrane of the left eye of the same patient in the previous image.
Late fundus fluorescein angiography confirming the active choroidal neovascular membrane of the left eye.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.