Photodynamic Therapy of Choroidal Neovascularization Associated With Angioid Streaks

Purpose: Natural history of choroidal neovascularization (CNV) associated with angioid streaks (AS) is unfavourable; the disease was reported to lead to legal blindness in half of eyes within one year. We describe the outcome of photodynamic therapy (PDT) for CNV associated with AS. Methods: Twenty-one patients (28 eyes) were included. Inclusion criteria were actively leaking CNV associated with AS. Results: Mean age was 63 years (44-81y). The CNV was subfoveal in 22 eyes and extrafoveal in 6. Nineteen eyes (17 patients) with subfoveal lesions and visual acuity (VA) of at least 20/200 (median: 20/60) were followed for 9.6 months on average (3-20 months). The Kaplan-Meyer estimate of the proportion of eyes which lost less than 3 lines was 69% between 7.5 and 12 months; however the 95% confidence interval of the estimate is large (46%-92%). In one eye of 3 different patients, who showed subfoveal CNV with VA between 20/400 and 20/800, VA improved by 3 to 6 lines. In 6 eyes (4 patients) with extrafoveal CNV (follow-up: 6-20 months), VA was 20/20-20/25 before PDT; progression to subfoveal CNV was avoided in 4 eyes of 2 patients, who retained baseline VA bilaterally. The CNV was smaller than 500 microns at the first PDT in these eyes. In 2 eyes which developed subfoveal involvement, final VA was 20/60 after 4 and 6 months respectively. Conclusion: About 70% of eyes (and at least 50% based on the Kaplan-Meyer estimate lower limit) are likely to have mild or no visual loss during the first year of PDT treatment for subfoveal CNV associated with AS. This outcome might be favourable given the aggressive untreated course of these lesions. PDT can avoid subfoveal invasion in some eyes with small extrafoveal CNV. Long term observation is needed.