Anti-vascular endothelial growth factor treatment for choroidal neovascularization secondary to angioid streaks in pseudoxanthoma elasticum： a case report and systemic review

The present study reports a case of a patient with choroidal neovascularization(CNV)associated with pseudoxanthoma elasticum(PXE).We observed the functional and anatomical improvement of the patient treated with intravitreal vascular endothelial growth factor(VEGF)inhibitor bevacizumab.The study also systematically searched the database for similar cases to provide a literature review.Data concerning the clinical features,treatment strategies and outcomes were extracted and analyzed.Retrospective interventional case report and systematic literature review.A 56-year-old healthy Chinese woman with CNV secondary to PXE was reported.Examinations included best corrected visual acuity(BCVA),biomicroscopy,optical coherence tomography(OCT),fluorescein and indocyanine green angiography and digital fundus photography.The patient managed with intravitreal anti-vascular endothelial growth factor(anti-VEGF)injections(bevacizumab 1.25 mg/0.05 m L).The Cochrane Library,Pub Med,OVID,and Up To Date databases were searched using the term pseudoxanthoma elasticum or Gr?nblad-Strandberg syndrome with the limits English.Articles that predated the databases were gathered from current references.Fundus examination revealed angioid streaks bilaterally and CNV in left eye(LE).After the patient underwent three intravitreal injections of bevacizumab,the LE showed absorption of the subretinal fluid and shrinkage of the CNV.Visual acuity(VA)was improved in her treated LE.Bevacizumab treatment was well tolerated with no adverse events reported.Approximately ten articles about 45 patients(49 eyes)describing CNV secondary to angioid streaks in PXE treated with anti-VEGF were found in the literature search.In the present case,bevacizumab of an initial three injection loading dose,achieved maintenance of visual function in the treatment of CNV associated with angioid streaks in PXE.Literature articles concluded that the intravitreal application of anti-VEGF is highly efficient for improving and stabilizing the lesion as well as the eyesight.So we believe that anti-VEGF therapy can be a great choice of treatment for CNV secondary to angioid streaks related PXE.

Triamcinolone-assisted Pars Plana Vitrectomy for Retinal Disease

Purpose:To determine whether triamcinolone acetonide (TA)staining facilitates posterior hyaloid removal in patients undergoing pars plana vitrectomy (PPV) for retinal disease.Methods: A triamcinolone acetonide(TA)-assisted vitrectomy was performed on patients with the following disease: proliferative diabetic retionpathy(5eyes), central retinal vein occlusion(5eyes), macuar hole (3eyes), and epiretinal membrane(2eyes). Eyes without apparent preoperative posterior vitreous detachment were enrolled in this study. After a core PPV, TA aqueous suspension (40 mg/ml) was injected into the mid vitreous cavity to visualize the posterior hyaloid, thus allowing a complete posterior hyaloid separation and removal. The visual acuity, intraocular pressure (IOP), tamponade, corneal pathology, after-cataract, vitreous hemorrhage, and necessity for reoperation were thereafter examined for at least 3 months after surgery.Results: In all patients, the vitreous body was clearly seen by means of triamcinolone during surgery, and complete removal of posterior hyaloid was facilitated and confirmed.Retina was attached in 14 of 15 eyes, and vision acuity was improved in 9 of 15 eyes.Two eyes showed transient postoperative IOP elevation, 2 eyes had after cataract formation and 1eye had cataract progression. Vitreous hemorrhage occurred in 1 eye. No eye had corneal pathology.Conclusion: Triamcinolone improved the visibility of the hyaloid and the safety of surgical procedures during PPV. No obvious adverse effect due to toxicity of TA accrued in TA-assisted PPV.