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[弹性假黄瘤继发脉络膜新生血管形成所致的血管样条纹:诊断与治疗。病例报告]

[Angioid streaks complicated by choroidal neovascularization secondary to pseudoxanthoma elasticum: diagnosis and treatment. Case report].

作者信息

Maalej A, Ouederni M, Khallouli A, Gabsi S

机构信息

Hôpital militaire de Tunis, 1008 Montfleury, Tunis, Tunisie.

出版信息

J Fr Ophtalmol. 2012 Dec;35(10):803-8. doi: 10.1016/j.jfo.2012.06.013. Epub 2012 Oct 22.

Abstract

Angioid streaks represent linear breaks in Bruch's membrane secondary to a change in the elastic layer. They are often associated with pseudoxanthoma elasticum. We report the case of a 36-year-old man with no prior history who was seen for a macular problem in the left eye, eventually involving the right eye after 3 months. He was diagnosed with pseudoxanthoma elasticum, associated with angioid streaks, complicated by choroidal neovascularization in both eyes. He was treated with intravitreal ranibizumab injections (0.5 mg/0.05 mL). His course in the right eye was remarkable for stable improvement at 3 months after the final injection. In the left eye, after initial improvement, recurrence was noted 2.5 months after injection, with subfoveal progression of the choroidal neovascularisation, unresponsive to a fourth ranibizumab injection. Angioid streaks represent a degenerative retinal pathology of elastic tissue with the potential for ingrowth of choroidal neovascularization. Various therapeutic approaches such as photodynamic therapy or laser photocoagulation have been proposed, with variable and sometimes limited results. Intravitreal ranibizumab injections currently remain the best treatment and should be studied with a longer-term, larger series.

摘要

血管样条纹是继发于弹性层改变的 Bruch 膜的线性破裂。它们常与弹性假黄瘤相关。我们报告一例 36 岁男性,既往无病史,因左眼黄斑问题就诊,3 个月后右眼也受累。他被诊断为弹性假黄瘤,伴有血管样条纹,双眼并发脉络膜新生血管。给予玻璃体内注射雷珠单抗(0.5 mg/0.05 mL)治疗。右眼在最后一次注射后 3 个月病情显著稳定改善。左眼在最初改善后,注射后 2.5 个月复发,脉络膜新生血管在黄斑下进展,对第四次雷珠单抗注射无反应。血管样条纹代表弹性组织的退行性视网膜病变,有脉络膜新生血管向内生长的可能。已提出多种治疗方法,如光动力疗法或激光光凝,但结果各异,有时效果有限。玻璃体内注射雷珠单抗目前仍是最佳治疗方法,应开展更大规模的长期研究。

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