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

Abstract

Angioid streaks are mainly characterized by radially striated lesions around the optical disc and result in severe vision loss when choroidal neovascularization (CNV) develops at the macula. The prediction of visual prognosis in cases with angioid streaks remains an unsolved problem. In this study, we report the usefulness of en-face optical coherence tomography (OCT) to assess the bilateral striated lesions in angioid streaks. A 59-year-old female who was previously diagnosed with angioid streaks complained of decreased visual acuity in her left eye. However, on en-face OCT, the striated lesions in the right eye with better vision were shown as thicker continuous lesions than those in the left eye. Twenty-four months after the initial visit, her right visual acuity was worse than her left. En-face OCT showed fine-striated lesions extending from those thicker lesions to the macular area in the right eye. The thicker striated lesions observed at the initial visit may be a risk factor for future CNV development and vision loss. The evaluation of lesion size using en-face OCT may be useful for predicting the visual prognosis in angioid streaks.

Keywords: angioid streaks; anti-vegf vitreous injection; c-scan optical coherence tomography; choroidal neovascularization; en-face optical coherence tomography.

Figure 1. Fundus photographs at the initial visit, A (right eye) and B (left eye), and B-Scan OCT of the fovea at the horizontal section, C (right eye) and D (left eye)

A: Right eye. Angioid streaks (striae radiating from the optic disc area to the peripapillary area) are shown (yellow arrows). B: Left eye. Angioid streaks (striae radiating from the optic disc area to the peripapillary area) are shown (yellow arrows). Retinal hemorrhage at the macula (white arrowhead) is observed. C: Right eye. The macular edema and intraretinal hyperreflective foci are seen. D: Left eye. The macular edema and the elevations of the retinal pigment epithelium layer (yellow arrowheads) are detected. The intraretinal hyperreflective foci are more frequent in the left eye. OCT: optical coherence tomography

Figure 2. En-face OCT images at the initial visit. In the right eye, A (transverse scan), B (horizontal scan), and C (3D view). In the left eye, D (transverse scan), E (horizontal scan), and F (3D view)

A: The striated lesions in the right eye are clearly shown in the transverse scan. B: Horizontal scan of the striated lesion in the right eye. The lesion is shown to be elevated (blue arrow, same location as A). C: Total 3D view of the striated lesion in the right eye. The striated lesion is shown to be continuous (same location as A and B). D: The striated lesions in the left eye are also clearly shown in the transverse scan. E: Horizontal scan of the striated lesion in the left eye. The lesion is smaller than that in the right eye (blue arrow, same location as D). F: Total 3D view of the striated lesion in the left eye. The striated lesion is continuous but smaller than in the right eye (same position as D and E). OCT: optical coherence tomography

Figure 3. Time course of the treatment in both eyes

Vertical axis of the line graph: BCVA (Log MAR). Horizontal axis of the line graph: time course. Blue line: visual acuity trend in the right eye. Orange line: visual acuity trend in the left eye. After five months of interruption, the right visual acuity was significantly worsened. In contrast, the left visual acuity was maintained. BCVA: best-corrected visual acuity, VEGF: vascular endothelial growth factor

Figure 4. Fundus photographs 24 months after the initial visit, A (right eye) and B (left eye), and B scan OCT of the fovea at the horizontal scan, C (right eye) and D (left eye)

A: Right eye. Several retinal hemorrhages are seen (white arrows). B: Left eye. There is no apparent hemorrhage. C: Right eye. The edema is worsening and there are elevations of the retinal pigment epithelium layer (yellow arrowheads) that were not present two years ago. D: Left eye. A slight edema is recognized, but there is no remarkable change in the elevation of the retinal pigment epithelium layer compared to two years ago. OCT: optical coherence tomography

Figure 5. En-face OCT images 24 months after the initial visit. In the right eye, A (transverse scan), B (horizontal scan), and C (3D view). In the left eye, D (transverse scan), E (horizontal scan), and F (3D view)

A: Fine-striated lesions are seen extending from the thick striae to the macula (red arrowheads). B: Horizontal scan of the macula area in the right eye. The lesion is shown to be elevated (blue arrow, same location as A). C: Total 3D view of the striated lesion in the right eye. The striated lesion is shown to be continuous (same location as A and B). D: Fine-striated lesions also extend to the macula in the left eye (red arrowheads). E: Horizontal scan of the striated lesion in the left eye. The lesion is smaller than that in the right eye (blue arrow, same location as D). F: Total 3D view of the striated lesion in the left eye. The striated lesion is continuous but smaller than in the right eye (same position as D and E). OCT: optical coherence tomography