MULTIMODAL IMAGING OF FOCAL CHOROIDAL EXCAVATION COMPLICATED BY CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH ANGIOID STREAKS AND PSEUDOXANTHOMA ELASTICUM
To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab. Fundus photography, fundus autofluorescence, fluorescein angiography,...
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| Published in: | Retinal cases & brief reports Vol. 15; no. 2; pp. 155 - 162 |
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Retinal Cases & Brief Reports
01-03-2021
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| Abstract | To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab.
Fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT angiography were performed in a 60-year-old white woman with angioid streaks and bilateral FCE. Spectral domain OCT images were taken before and after three-monthly intravitreal injections of bevacizumab. Histopathological analysis of the dermis established the diagnosis of pseudoxanthoma elasticum.
Multimodal imaging revealed bilateral FCE and CNV. Spectral domain OCT diagnosed bilateral FCE and Type-1 and Type-2 CNV in the right eye, and irregular vascular network, along macular streak, in both eyes, which were not observed on fluorescein neither on indocyanine green angiography, but only on SD-OCT angiography. Patient presented good anatomical and functional response to intravitreal injections of bevacizumab.
Focal choroidal excavation is a rare condition detected mainly by SD-OCT, which may be associated with angioid streaks secondary to pseudoxanthoma elasticum and complicated by CNV. Multimodal imaging is important for diagnosis and follow-up of such patients, even in the absence of signs of CNV, and anatomical and functional response to anti-vascular endothelial growth factor therapy is good. |
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| AbstractList | To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab.
Fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT angiography were performed in a 60-year-old white woman with angioid streaks and bilateral FCE. Spectral domain OCT images were taken before and after three-monthly intravitreal injections of bevacizumab. Histopathological analysis of the dermis established the diagnosis of pseudoxanthoma elasticum.
Multimodal imaging revealed bilateral FCE and CNV. Spectral domain OCT diagnosed bilateral FCE and Type-1 and Type-2 CNV in the right eye, and irregular vascular network, along macular streak, in both eyes, which were not observed on fluorescein neither on indocyanine green angiography, but only on SD-OCT angiography. Patient presented good anatomical and functional response to intravitreal injections of bevacizumab.
Focal choroidal excavation is a rare condition detected mainly by SD-OCT, which may be associated with angioid streaks secondary to pseudoxanthoma elasticum and complicated by CNV. Multimodal imaging is important for diagnosis and follow-up of such patients, even in the absence of signs of CNV, and anatomical and functional response to anti-vascular endothelial growth factor therapy is good. PURPOSETo describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab. METHODSFundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT angiography were performed in a 60-year-old white woman with angioid streaks and bilateral FCE. Spectral domain OCT images were taken before and after three-monthly intravitreal injections of bevacizumab. Histopathological analysis of the dermis established the diagnosis of pseudoxanthoma elasticum. RESULTSMultimodal imaging revealed bilateral FCE and CNV. Spectral domain OCT diagnosed bilateral FCE and Type-1 and Type-2 CNV in the right eye, and irregular vascular network, along macular streak, in both eyes, which were not observed on fluorescein neither on indocyanine green angiography, but only on SD-OCT angiography. Patient presented good anatomical and functional response to intravitreal injections of bevacizumab. CONCLUSIONFocal choroidal excavation is a rare condition detected mainly by SD-OCT, which may be associated with angioid streaks secondary to pseudoxanthoma elasticum and complicated by CNV. Multimodal imaging is important for diagnosis and follow-up of such patients, even in the absence of signs of CNV, and anatomical and functional response to anti-vascular endothelial growth factor therapy is good. |
| Author | Monteiro, Mário Luiz Ribeiro Schmidt, Marina Brandão Ferreira, Bruno Fortaleza de Aquino Zacharias, Leandro Cabral Preti, Rony Carlos Takahashi, Walter Yukihiko |
| AuthorAffiliation | Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil |
| AuthorAffiliation_xml | – name: Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil |
| Author_xml | – sequence: 1 givenname: Bruno Fortaleza de Aquino surname: Ferreira fullname: Ferreira, Bruno Fortaleza de Aquino organization: Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil – sequence: 2 givenname: Rony Carlos surname: Preti fullname: Preti, Rony Carlos – sequence: 3 givenname: Marina Brandão surname: Schmidt fullname: Schmidt, Marina Brandão – sequence: 4 givenname: Leandro Cabral surname: Zacharias fullname: Zacharias, Leandro Cabral – sequence: 5 givenname: Walter Yukihiko surname: Takahashi fullname: Takahashi, Walter Yukihiko – sequence: 6 givenname: Mário Luiz Ribeiro surname: Monteiro fullname: Monteiro, Mário Luiz Ribeiro |
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| References | Georgalas (R19-20240809) 2009; 5 Corbelli (R20-20240809) 2017 Clarkson (R14-20240809) 1982; 26 Lee (R6-20240809) 2014; 157 Ellabban (R15-20240809) 2013; 156 Margolis (R2-20240809) 2011; 129 Metelitsina (R18-20240809) 2008; 49 Xu (R22-20240809) 2014; 121 Liu (R4-20240809) 2015; 8 Or (R17-20240809) 2014; 45 Xu (R23-20240809) 2010; 150 Castro Navarro (R5-20240809) 2016; 91 Ghadiali (R9-20240809) 2016; 10 Shields (R12-20240809) 1975; 59 Jampol (R1-20240809) 2006; 26 Guo (R7-20240809) 2014; 14 Hashimoto (R16-20240809) 2014; 14 Lim (R3-20240809) 2016; 100 Tilleul (R13-20240809) 2016; 36 Corbelli (R10-20240809) 2017 Iacono (R11-20240809) 2016; 165 Obata (R8-20240809) 2013; 33 Spaide (R21-20240809) 2015; 35 |
| References_xml | – volume: 8 start-page: 513 year: 2015 ident: R4-20240809 article-title: Focal choroidal excavation: a preliminary interpretation based on clinic and review publication-title: Int J Ophthalmol contributor: fullname: Liu – volume: 14 start-page: 63 year: 2014 ident: R7-20240809 article-title: Clinical and optic coherence tomography findings of focal choroidal excavation in Chinese patients publication-title: BMC Ophthalmol doi: 10.1186/1471-2415-14-63 contributor: fullname: Guo – volume: 36 start-page: 483 year: 2016 ident: R13-20240809 article-title: Intravitreal Ranibizumab for choroidal neovascularization in angioid streaks: four-year follow-up publication-title: Retina doi: 10.1097/IAE.0000000000000745 contributor: fullname: Tilleul – year: 2017 ident: R20-20240809 article-title: Optical coherence tomography angiography features of angioid streaks publication-title: Retina contributor: fullname: Corbelli – volume: 91 start-page: 34 year: 2016 ident: R5-20240809 article-title: Focal choroidal excavation: clinical findings and complications publication-title: Arch Soc Esp Oftalmol doi: 10.1016/j.oftal.2015.10.004 contributor: fullname: Castro Navarro – volume: 33 start-page: 1201 year: 2013 ident: R8-20240809 article-title: Tomographic and angiographic characteristics of eyes with macular focal choroidal excavation publication-title: Retina doi: 10.1097/IAE.0b013e31827b6452 contributor: fullname: Obata – volume: 121 start-page: 246 year: 2014 ident: R22-20240809 article-title: Focal choroidal excavation complicated by choroidal neovascularization publication-title: Ophthalmology doi: 10.1016/j.ophtha.2013.08.014 contributor: fullname: Xu – volume: 26 start-page: 1072 year: 2006 ident: R1-20240809 article-title: Diagnostic and therapeutic challenges publication-title: Retina doi: 10.1097/01.iae.0000248819.86737.a5 contributor: fullname: Jampol – volume: 59 start-page: 257 year: 1975 ident: R12-20240809 article-title: Angioid streaks. 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| Snippet | To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary... PURPOSETo describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks... |
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| Title | MULTIMODAL IMAGING OF FOCAL CHOROIDAL EXCAVATION COMPLICATED BY CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH ANGIOID STREAKS AND PSEUDOXANTHOMA ELASTICUM |
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