Angioid Streak - Peau D'Orange - Pseudoxanthoma Elasticum - Regressed CNVM with Avastin
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60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at the moment.
VISUAL ACUITY: Vision OD is 20/20, OS is 20/25. IOP: OD 13, OS 14.
SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a well-circumscribed pigment epithelial detachment just on the nasal edge of the optic nerve extending from 2:30 to 3:30 o’clock, about 1000 microns off the nerve with a rim of blood around it. There are angioid streaks with cracks circling the nerve and there is one line that goes inferior to the center of the fovea.
OS: Vertical C/D ratio is 0.5. There are angioid streaks circling the nerve and then one again going through the fovea. There is a little pigment epithelial irregularity nasal to the fovea. She also has striking peau d’orange changes in the periphery temporally.
OCT SCAN: The OCT scan shows no intraretinal or subretinal fluid in the macula of either eye.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: The FA does show an occult juxtapapillary extrafoveal choroidal neovascular membrane on the nasal edge of the optic nerve in the right eye with blockage where the hemorrhage is. The left eye also shows an area of hyperfluorescence nasal to the foveal which looks like where the choroidal neovascular membrane was, which regressed with the Avastin treatment.
IMPRESSION:
1. ANGIOID STREAK-TYPE MACULAR DEGENERATION – BOTH EYES
2. JUXTAPAPILLARY EXTRAFOVEAL ASYMPTOMATIC CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE
3. INVOLUTED SUBRETINAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE
DISCUSSION: I explained to the patient the macula in the left eye is dry. The right eye does have a little neovascularization but it is nasal to the optic nerve and does not look to be threatening.
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane1045 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at 
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane964 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane680 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane980 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane965 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane808 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane796 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane629 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane553 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane713 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane643 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane796 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane1184 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane586 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane739 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane591 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane637 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane497 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane414 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane469 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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Angioid Streaks - Peau D'Orange - Pseudoxanthoma Elasticum - Asymptomatic Extrafoveal Choroidal Neovascular Membrane510 views60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at
(0 votes)
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60-year-old woman has pseudoxanthoma elasticum since 2008. Her sister has the same problem and lost vision in both eyes. She had a problem with blood vessel growth in the left eye for which she had injections of Avastin in August, September, and October of 2011 (5 months ago). Subsequent to that, the macula has been dry and you have just been watching her carefully. She is in Florida for a short time but will ultimately be spending nine months out of the year here. Both of her eyes have good vision at the moment.
VISUAL ACUITY: Vision OD is 20/20, OS is 20/25. IOP: OD 13, OS 14.
SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a well-circumscribed pigment epithelial detachment just on the nasal edge of the optic nerve extending from 2:30 to 3:30 o’clock, about 1000 microns off the nerve with a rim of blood around it. There are angioid streaks with cracks circling the nerve and there is one line that goes inferior to the center of the fovea.
OS: Vertical C/D ratio is 0.5. There are angioid streaks circling the nerve and then one again going through the fovea. There is a little pigment epithelial irregularity nasal to the fovea. She also has striking peau d’orange changes in the periphery temporally.
OCT SCAN: The OCT scan shows no intraretinal or subretinal fluid in the macula of either eye.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: The FA does show an occult juxtapapillary extrafoveal choroidal neovascular membrane on the nasal edge of the optic nerve in the right eye with blockage where the hemorrhage is. The left eye also shows an area of hyperfluorescence nasal to the foveal which looks like where the choroidal neovascular membrane was, which regressed with the Avastin treatment.
IMPRESSION:
1. ANGIOID STREAK-TYPE MACULAR DEGENERATION – BOTH EYES
2. JUXTAPAPILLARY EXTRAFOVEAL ASYMPTOMATIC CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE
3. INVOLUTED SUBRETINAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE
DISCUSSION: I explained to the patient the macula in the left eye is dry. The right eye does have a little neovascularization but it is nasal to the optic nerve and does not look to be threatening.
