PMC3402123_01
Case 1. (A) Active subfoveal CNV membrane OS with subretinal hemorrhage connected to area of angioid streaks. Intravenous fluorescein angiography showed classic subfoveal choroidal neovascular membrane with leakage at the end of the study. (B) Healed CNV OS. (C) Active juxtafoveal CNV emanating from angioid streaks OD with subretinal hemorrhage. Lower left picture shows response to treatment. (D) Active subfoveal CNV OD emanating from the previous CNV. (E) Healed CNV OD.. Abbreviation: CNV, choroidal neovascularization.
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The fundus findings were confirmed by intravenous fluorescein angiography and optical coherence tomography which showed classical subfoveal CNV that leaked at the end of the study, there was evidence of angioid streaks emanating from the optic disc with evidence of peau d'orange appearance at the posterior pole of the fundus in both eyes (Figure 1A). However, at 3 months, the patient developed a large fibrotic membrane with a concurrent drop in vision to 20/300 (Figure 1B). Subsequent clinical evaluation indicated stable vision and no leakage from CNV, confirmed by intravenous fluorescein angiography and optical coherence tomography (Figure 1C). The patient received the same regimen of intravitreal bevacizumab for 3 months (Figure 1D). The CNV was quiescent at 4 years follow-up (last visit to date), and his vision was 20/300 in both eyes secondary to a large fibrotic macular scar (Figure 1E).
PMC3402123_02
Case 2. (A) Active subfoveal CNV with active subretinal hemorrhage and subretinal fluid confirmed by intravenous fluorescein angiography that demonstrated classical subfoveal CNV with active leakage. In addition, there is evidence of angioid streaks emanating from the optic disc with evidence of peau d'orange fundus in both eyes. (B) Upper right active extrafoveal CNV OD. Upper left after laser treatment OD. Lower right enlargement of laser scar OD. Lower left active recurrent CNV OS. (C) Left column, new active CNV OD. Right column, active CNV OS. (D and E) Submacular fibrosis OU.. Abbreviation: CNV, choroidal neovascularization.
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In addition, there was evidence of angioid streaks emanating from the optic disc with evidence of peau d'orange fundus in both eyes (Figure 2A). However, CNV in OS showed reactivation, which prompted monthly intravitreal injection of bevacizumab 1.25 mg/0.05 mL for 3 months (Figure 2B). Vision was 20/160 and, clinically, the choroidal neovascular membrane was large and more active, incorporating the central macula (Figure 2C). The last follow-up for this patient was after 6 years and her vision in both eyes was 20/300 secondary to extensive submacular fibrosis (Figure 2D and E).