Choroidal neovascularization after blunt ocular trauma in angioid streaks

Masaomi Kubota, Takaaki Hayashi, Kota Arai, Hiroshi Tsuneoka

Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan

Background: Patients with angioid streaks are prone to develop a subretinal hemorrhage after ocular injury, due to fragility of Bruch's membrane.
Objective: The purpose of this study was to report a patient with angioid streaks in whom subfoveal choroidal neovascularization (CNV) developed after blunt ocular trauma.
Case report: A 60-year-old man was accidentally struck in the left eye with a crowbar handle while engaged in the demolition of wooden building materials in May 2011 and was initially evaluated at our hospital. Corrected visual acuity was 0.3 in the right and 1.2 in the left eye, and relative afferent pupillary defect was negative. Funduscopy revealed choroidal atrophy around the optic papillae and angioid streaks radiating from around the optic discs in both eyes. In the right eye, there was macular atrophy. In the left eye, there was a subretinal hemorrhage around the macular region. Fluorescein angiography of the left eye showed a blockage due to subretinal hemorrhage and increasing hyperfluorescent spots superior to the fovea, suggestive of extrafoveal CNV. Spectral-domain optical coherence tomography showed macular thinning in the right eye and no obvious abnormalities near the subfoveal region in the left eye. Two months later, the patient noticed decreased visual acuity in the left eye and was reevaluated. Visual acuity had decreased to 0.7, and well-defined CNV, one disc diameter in size, was presenting slightly superior to the macula, including the subfoveal region. Two weeks later, anti-vascular endothelial growth factor (anti-VEGF) antibody (bevacizumab) was injected intravitreally; the CNV then regressed, and visual acuity improved to 1.2.
Conclusion: Marked improvement in visual acuity with early treatment has not been reported in angioid streaks with subfoveal CNV after ocular injury. Intravitreal injection of an anti-VEGF antibody should be considered early after the diagnosis of CNV.

Keywords: pseudoxanthoma elasticum, subretinal hemorrhage, anti-VEGF therapy