Wong James G, Qian Katherine Yu
Strathfield Retina Clinic, Sydney, NSW, Australia.
Case Rep Ophthalmol. 2017 Apr 10;8(1):221-231. doi: 10.1159/000468144. eCollection 2017 Jan-Apr.
Angioid streaks (AS) are dehiscences in Bruch's membrane that may be idiopathic or associated with numerous systemic illnesses. Polypoidal choroidal vasculopathy (PCV) is an underdiagnosed exudative chorioretinopathy often characterised by serosanguineous detachments of the pigmented epithelium. The use of the anti-VEGF agents ranibizumab and aflibercept in the management of PCV secondary to AS has not been previously documented. We report 3 patients with active PCV secondary to AS, 1 of which had a family history of PCV secondary to AS, not previously reported in the literature. All patients were symptomatic and treated with intravitreal anti-VEGF therapy with and without combination photodynamic therapy (PDT).
This is a long-term retrospective case review of 3 eyes of 3 patients with AS and clinical features of PCV. The patients were examined using fundoscopy, spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All patients were managed with intravitreal anti-VEGF using a treat-and-extend protocol according to specific retreatment criteria. One patient had 1 session of PDT in combination with anti-VEGF injections.
The mean follow-up time in all patients was 4 years. In all 3 cases, the treatment resulted in improved visual acuity and regression of active PCV lesions with a longer duration between injections.
The treat-and-extend protocol with intravitreal aflibercept or ranibizumab with or without PDT is effective and safe for PCV secondary to AS.
血管样条纹（AS）是 Bruch 膜的裂隙，可能是特发性的，也可能与多种全身性疾病相关。息肉样脉络膜血管病变（PCV）是一种诊断不足的渗出性脉络膜视网膜病变，通常以色素上皮的浆液性出血性脱离为特征。抗 VEGF 药物雷珠单抗和阿柏西普用于治疗继发于 AS 的 PCV 此前未见文献报道。我们报告 3 例继发于 AS 的活动性 PCV 患者，其中 1 例有继发于 AS 的 PCV 家族史，此前文献未报道过。所有患者均有症状，接受了玻璃体腔内抗 VEGF 治疗，部分联合光动力疗法（PDT）。
这是一项对 3 例患有 AS 且具有 PCV 临床特征患者的 3 只眼进行的长期回顾性病例分析。使用检眼镜、频域光学相干断层扫描、荧光素血管造影和吲哚菁绿血管造影对患者进行检查。所有患者均根据特定的再治疗标准采用“治疗并延长”方案进行玻璃体腔内抗 VEGF 治疗。1 例患者接受了 1 次 PDT 联合抗 VEGF 注射。
所有患者的平均随访时间为 4 年。在所有 3 例病例中，治疗均使视力提高，活动性 PCV 病变消退，且注射间隔时间延长。
玻璃体腔内注射阿柏西普或雷珠单抗联合或不联合 PDT 的“治疗并延长”方案对继发于 AS 的 PCV 有效且安全。
