To investigate the effect and the safety of intravitreal aflibercept in patients affected by choroidal neovascularization secondary to angioid streaks with a long-term follow-up.
Methods
Multicentre, open-label, phase IIb study (EYLEA-STRIE, EudraCT Number 2014-000986-30) involving four Italian centres (IRCCS Ospedale San Raffaele (Milano), Fondazione G.B. Bietti (Roma), Policlinico (Milano), Ospedale Luigi Sacco (Milano)). Patients with active choroidal neovascularization secondary to angioid streaks with foveal involvement were prospectively enrolled and followed for 18 months. All the patients received intravitreal 2 mg/0.05 mL aflibercept at the time of enrolment, followed by a pro-re-nata regimen for 48 weeks. Best-corrected visual acuity and central macular thickness were measured monthly. Adverse events were monitored at each visit.
Results
Twenty-three eyes of 20 patients were analysed. Mean number of injections per patient was 4.30 ± 1.2. At week 48, the best-corrected visual acuity was 0.42 ± 0.40 LogMAR (p = 0.6 from baseline) and 18 eyes (81.8%) featured stability within 15 letters. The central macular thickness significantly reduced (p = 0.03). Eleven ocular non-serious adverse events and two serious adverse events were observed (one case of endophthalmitis and one case of acute gastritis were reported).
Conclusion
Intravitreal aflibercept represents a valid option for the management of choroidal neovascularization complicating angioid streaks. Further studies with longer follow-up and different therapeutic regimens are warranted to ascertain the best control of the disease.
LimJIBresslerNMMarshMJ, et al.
Laser treatment of choroidal neovascularization in patients with angioid streaks. Am J Ophthalmol1993;
116(4): 414–423.
3.
PeceAAvanzaPGalliL, et al.
Laser photocoagulation of choroidal neovascularization in angioid streaks. Retina1997;
17(1): 12–16.
4.
Al-RashaedSArevaloJF.Long-term follow-up of choroidal neovascularization secondary to angioid streaks: case series and literature review. Clin Ophthalmol2012;
6: 1029–1034.
5.
BrancatoRMenchiniUPeceA, et al.
Laser treatment of macular subretinal neovascularizations in angioid streaks.Ophthalmologica1987;
195(2): 84–87.
6.
ArasCBasererTYolarM, et al.
Two cases of choroidal neovascularization treated with transpupillary thermotherapy in angioid streaks.Retina2004;
24(5): 801–803.
7.
OzdekSBozanEGurelikG, et al.
Transpupillary thermotherapy for the treatment of choroidal neovascularization secondary to angioid streaks. Can J Ophthalmol2007;
42(1): 95–100.
8.
MenchiniUVirgiliGIntroiniU, et al.
Outcome of choroidal neovascularization in angioid streaks after photodynamic therapy.Retina2004;
24(5): 763–771.
9.
PeceARussoGRicciF, et al.
Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks. Clin Ophthalmol2010;
4: 525–530.
10.
AdelbergDADel PrioreLVKaplanHJ.Surgery for subfoveal membranes in myopia, angioid streaks, and other disorders.Retina1995;
15(3): 198–205.
11.
RothDBEstafanousMLewisH.Macular translocation for subfoveal choroidal neovascularization in angioid streaks. Am J Ophthalmol2001;
131(3): 390–392.
12.
GliemMFingerRPFimmersR, et al.
Treatment of choroidal neovascularization due to angioid streaks: a comprehensive review. Retina2013;
33(7): 1300–1314.
13.
TeixeiraAMattosTVelletriR, et al.
Clinical course of choroidal neovascularization secondary to angioid streaks treated with intravitreal bevacizumab.Ophthalmic Surg Lasers Imaging2010;
41(5): 546–549.
14.
LadasIDKotsolisAILadasDS, et al.
Intravitreal ranibizumab treatment of macular choroidal neovascularization secondary to angioid streaks: one-year results of a prospective study. Retina2010;
30(8): 1185–1189.
15.
FingerRPCharbel IssaPSchmitz-ValckenbergS, et al.
Long-term effectiveness of intravitreal bevacizumab for choroidal neovascularization secondary to angioid streaks in pseudoxanthoma elasticum. Retina2011;
31(7): 1268–1278.
16.
MyungJSBhatnagarPSpaideRF, et al.
Long-term outcomes of intravitreal antivascular endothelial growth factor therapy for the management of choroidal neovascularization in pseudoxanthoma elasticum.Retina2010;
30(5): 748–755.
17.
ShahMAmoakuWM.Intravitreal ranibizumab for the treatment of choroidal neovascularisation secondary to angioid streaks.Eye (Lond)2012;
26(9): 1194–1198.
18.
TilleulJMimounGQuerquesG, et al.
Intravitreal ranibizumab for choroidal neovascularization in angioid streaks: four-year follow-up.Retina2016;
36(3): 483–491.
19.
GliemMBirtelJHerrmannP, et al.
Aflibercept for choroidal neovascularizations secondary to pseudoxanthoma elasticum: a prospective study.Graefes Arch Clin Exp Ophthalmol2020;
258(2): 311–318.
20.
EsenESizmazSDemircanN.Intravitreal aflibercept for management of subfoveal choroidal neovascularization secondary to angioid streaks.Indian J Ophthalmol2015;
63(7): 616–618.
21.
SekfaliRMimounGCohenSY, et al.
Switching from ranibizumab to aflibercept in choroidal neovascularization secondary to angioid streaks.Eur J Ophthalmol2019;
30: 550–556.
22.
MakriOETsapardoniFNPlotasP, et al.
Intravitreal aflibercept for choroidal neovascularization secondary to angioid streaks in a non-responder to intravitreal ranibizumab.Int Med Case Rep J2018;
11: 229–231.
23.
TetikogluMSagdikHMAktasS, et al.
Intravitreal aflibercept for refractory choroidal neovascularization secondary to angioid streaks.Eye (Lond)2016;
30(6): 894–895.
24.
RushRBRushSWAragonAV2nd, et al.
Evaluation of choroidal neovascularization with indocyanine green angiography in neovascular age-related macular degeneration subjects undergoing intravitreal bevacizumab therapy.Am J Ophthalmol2014;
158(2): 337–344.
25.
SpaideRF.Peau d’orange and angioid streaks: manifestations of Bruch membrane pathology.Retina2015;
35(3): 392–397.
26.
GorgelsTGTeelingPMeeldijkJD, et al.
Abcc6 deficiency in the mouse leads to calcification of collagen fibers in Bruch’s membrane.Exp Eye Res2012;
104: 59–64.
27.
SpraulCWLangGEGrossniklausHE.Morphometric analysis of the choroid, Bruch’s membrane, and retinal pigment epithelium in eyes with age-related macular degeneration. Invest Ophthalmol Vis Sci1996;
37(13): 2724–2735.
28.
BhatnagarPFreundKBSpaideRF, et al.
Intravitreal bevacizumab for the management of choroidal neovascularization in pseudoxanthoma elasticum.Retina2007;
27(7): 897–902.
29.
NeriPSalvoliniSMariottiC, et al.
Long-term control of choroidal neovascularisation secondary to angioid streaks treated with intravitreal bevacizumab (Avastin). Br J Ophthalmol2009;
93(2): 155–158.
30.
WiegandTWRogersAHMcCabeF, et al.
Intravitreal bevacizumab (Avastin) treatment of choroidal neovascularisation in patients with angioid streaks.Br J Ophthalmol2009;
93(1): 47–51.
31.
KangSRohYJ.Intravitreal ranibizumab for choroidal neovascularisation secondary to angioid streaks.Eye (Lond)2009;
23(8): 1750–1751.
32.
KovachJLSchwartzSGHickeyM, et al.
Thirty-two month follow-up of successful treatment of choroidal neovascularization from angioid streaks with intravitreal bevacizumab.Ophthalmic Surg Lasers Imaging2009;
40(1): 77–79.
33.
Schiano LomorielloDParravanoMCChiaravallotiA, et al.
Choroidal neovascularization in angioid streaks and pseudoxanthoma elasticum: 1 year follow-up.Eur J Ophthalmol2009;
19(1): 151–153.
34.
LazarosKLeonidasZ.Intravitreal ranibizumab as primary treatment for neovascular membrane associated with angioid streaks.Acta Ophthalmol2010;
88(3): e100–111.
35.
SawaMGomiFTsujikawaM, et al.
Long-term results of intravitreal bevacizumab injection for choroidal neovascularization secondary to angioid streaks.Am J Ophthalmol2009;
148(4): 584–590.
36.
VadalaMPeceACipollaS, et al.
Angioid streak-related choroidal neovascularization treated by intravitreal ranibizumab.Retina2010;
30(6): 903–907.
37.
MimounGTilleulJLeysA, et al.
Intravitreal ranibizumab for choroidal neovascularization in angioid streaks.Am J Ophthalmol2010;
150(5): 692691–692700.
38.
El MatriLKortFBouraouiR, et al.
Intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to angioid streaks: one year of follow-up.Acta Ophthalmol2011;
89(7): 641–646.
39.
FingerRPCharbel IssaPHendigD, et al.
Monthly ranibizumab for choroidal neovascularizations secondary to angioid streaks in pseudoxanthoma elasticum: a one-year prospective study. Am J Ophthalmol2011;
152(4): 695–703.
40.
Battaglia ParodiMIaconoPLa SpinaC, et al.
Intravitreal bevacizumab for nonsubfoveal choroidal neovascularization associated with angioid streaks.Am J Ophthalmol2014;
157(2): 374–377.
41.
Vaz-PereiraSCollacoLDe SalvoG, et al.
Intravitreal aflibercept for choroidal neovascularisation in angioid streaks.Eye (Lond)2015;
29(9): 1236–1238.
42.
RosinaCRomanoMCigadaM, et al.
Intravitreal bevacizumab for choroidal neovascularization secondary to angioid streaks: a long-term follow-up study.Eur J Ophthalmol2015;
25(1): 47–50.
43.
AlagozCAlagozNOzkayaA, et al.
Intravitreal bevacizumab in the treatment of choroidal neovascular membrane due to angioid streaks. Retina2015;
35(10): 2001–2010.
44.
IaconoPBattaglia ParodiMLa SpinaC, et al.
Intravitreal bevacizumab for nonsubfoveal choroidal neovascularization associated with angioid streaks: 3-Year follow-up study.Am J Ophthalmol2016;
165: 174–178.
45.
LekhaTPrasadHNSarwateRN, et al.
Intravitreal bevacizumab for choroidal neovascularization associated with angioid streaks: long-term results.Middle East Afr J Ophthalmol2017;
24(3): 136–142.
46.
Battaglia ParodiMRomanoFMarcheseA, et al.
Anti-VEGF treatment for choroidal neovascularization complicating pattern dystrophy-like deposit associated with pseudoxanthoma elasticum.Graefes Arch Clin Exp Ophthalmol2019;
257(2): 273–278.
47.
SarwarSClearfieldESolimanMK, et al.
Aflibercept for neovascular age-related macular degeneration. Cochrane Database Syst Rev2016;
2: CD011346.
