Angioid Streaks

Excerpt

Angioid streaks represent disruptions in a deteriorated and calcified Bruch membrane linked with retinal bleeding, either occurring spontaneously or following blunt injury. Typically, they develop around the optic disc and extend outward linearly. These streaks can be idiopathic or associated with systemic conditions such as the rare disease pseudoxanthoma elasticum (PXE, MIM #264800), Ehlers-Danlos syndrome, sickle cell disease, and Paget disease of the bone. The invasion of choroidal fibrovascular tissue into the sub-retinal epithelial space may result in bleeding, neovascularization, and scarring, ultimately leading to symptoms like metamorphopsia or decreased visual acuity. Individuals with angioid streaks face the risk of subretinal bleeding, even from minor injuries.

Affected patients are often asymptomatic. In asymptomatic patients, continued observation is the only necessary management. In cases where neovascularization occurs, early intervention with anti-vascular endothelial growth factor (VEGF) forms the mainstay of treatment. Combining photodynamic therapy with medications like bevacizumab can also help regress choroidal neovascularization. Timely intervention, coupled with the use of protective eyewear to prevent future trauma, plays a crucial role in enhancing overall outcomes and reducing the likelihood of future choroidal rupture and bleeding.