A case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in angioid streaks

Abstract

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 µm at baseline to 203 µm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.

Keywords: Angioid streaks; Intravitreal bevacizumab injection; Subfoveal choroidal neovascularization.

Fig. 1

Early (A) and late (B) phase of fluorescein angiography (FAG) showing previous juxtafoveal classic choroidal neovascularization (CNV) that increased and progressed into the subfoveal area despite a photodynamic therapy treatment. (C) Early phase of indocyanine green angiography showing a more distinct margin of the subfoveal CNV lesion than FAG. (D) Late phase of indocyanine green angiography showing a peau d'orange appearance in the posterior pole with hyperfluorescent angioid streaks connected to the CNV lesion in late phase, which were not seen in FAG. (E) Optical coherence tomography showing a hyperreflective subfoveal choroidal neovascular membrane with cystoid macular edema and neurosensory serous detachment.

Fig. 2

At 12 months after a total of six intravitreal bevacizumab injections. (A) Color fundus photograph showing resolution of subretinal hemorrhage and exudates and the contracted subfoveal lesion. Early (B) and late (C) phase of fluorescein angiography and early (E) and late (F) phase of indocyanine green angiography revealing leakage resolution. (D) Optical coherence tomography showing a decrease in central macular thickness and absence of intraretinal fluid with normal foveal contour.