Pdf progressive symmetric vertical macular wide angioid. Angioid streaks light microscopy and oct retina image bank. Angioid streaks are often associated with pseudoxanthoma elasticum, but have been found to occur in conjunction with other disorders, including pagets disease, sickle cell disease and ehlersdanlos syndrome. A 54yearold caucasian man with history of heart disease presented with visual loss in his right eye. Progressive symmetric vertical macular wide angioid streak like lacquer crack. Most patients are asymptomatic but secondary complications can. There were 67 chinese subjects from shanghai included for our study, both eyes of the patients were examined, and we excluded 19 eyes with the following conditions. Since all the retinal structures are so thin and stretched, a lot of light is reflected off the choroid and it makes the choroidal vasculature much more prominent and visible. General workup is important to diagnose and treat other aspects of the disease that may be life threatening, such as gi hemorrhage, heart disease, anemia, and pathological fractures. The streaks intercommunicate in a ringlike fashion around the optic disc in 27% of cases and radiate outward in a tapering fashion from the. The eye in systemic disease lacquer cracks choroidal rupture high myopia trauma masqueraders of angioid streaks differential dx. Learn more about angioid streaks from related diseases, pathways, genes and ptms with the novus bioinformatics tool. Angioid streaks and optic disc drusen in pseudoxanthoma. Choroidal neovascularization was bilateral in 8 eyes 47%.
It is still uncertain whether laser photocoagulation is beneficial in the. Purpose to examine the clinical characteristics of periconus choroidal neovascularizations cnvs in eyes with pathologic myopia. Angioid streaks usually present as linear gray or dark red lines with irregular serrated edges lying beneath normal retinal blood vessels. Named because of their resemblance to blood vessels. A periconus cnv was defined as a cnv that is located. Color photographs showed areas of yellowish opacification that obscured. The aim of this study was to characterize peau dorange and angioid streaks, characteristic findings in eyes of patients with pseudoxanthoma elasticum, by examining fundus photography and optical coherence tomography imaging. Jun 11, 2016 angioid streaks ehlersdanlos syndromes ehlersdanlos syndromes eds comprise a heterogeneous group of diseases of the connective tissue. Bruch s membrane rupture, choroidal rupture, choroidal neo vascularization, high myopia, lacquer crack, lasik.
How often are angioid streaks associated with systemic dz. Jan 11, 20 angioid streaks photographer alfredo gomezleal, md top and gerardo garciaaguirre, md bottom description top. Optic neuropathy and retinal complications after refractive surgery. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Angioid streaks is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. Pdf longterm followup of choroidal neovascularization. Pseudoxanthoma elasticum pxe is a systemic disorder that affects the elastic tissue of the skin, the eye, and the cardiovascular and gastrointestinal systems. Wills eye manual pages 351 400 text version fliphtml5. These findings offer grounds for speculation on the pathogenesis of progressive myopic visual changes. Choroidal neovascularization is a common cause of neovascular degenerative maculopathy i.
Mar 26, 2009 angioid streaks are evident in fundoscopy a few millimetres from the optic disc and rarely occur in the periphery of the posterior pole. Myopic macular degeneration is a generalized diagnosis and disease process that may include a multitude of findings such as lacquer cracks, cnv and macular hemorrhage 6. Cnv like myopia, trauma, ocular histoplasmosis and angioid streaks 6. Jul 22, 2019 angioid streaks usually present as linear gray or dark red lines with irregular serrated edges lying beneath normal retinal blood vessels. The incidence of cnv in patients with angioid streaks varies between 72%86% in numerous studies. Subretinal neovascular membranes have been found in 30% of eyes with lacquer cracks and 75% of eyes with angioid streaks. Characteristics of periconus choroidal neovascularization. Optical coherence tomography images were evaluated for reflectivity pattern of the band corresponding to the retinal pigment epitheliumbruch membrane complex. Clinical findings and management of pathological myopic. Look for lacquer cracks in high myopes for early warning of.
Angioid streaks and optic disc drusen in pseudoxanthoma elasticum. What are lacquer cracks, yellow streaks, and breaks in bruchs associated with. They are also called knapps striae as he first coined the term in 1892 because of their marked resemblance to blood vessels. The basic pathological association among all causes is damage to the elastic lamina of bruchs membrane. Seen with pseudoxanthoma elasticum most commonly, ehlers danlos syndrome, pagets disease, sickle cell anemia, or idiopathic pepsi. Longterm followup of choroidal neovascularization secondary to angioid streaks.
Angioid streaks harvard catalyst profiles harvard catalyst. Look for lacquer cracks in high myopes for early warning. No lacquer crack was present in the macula on either fluorescein or indocyanine green angiography before treatment. Angioid streaks with cnvm oct re retina image bank. Commonly, neovascularization involves both eyes, but does not occur simultaneously. Angioid streaks ehlersdanlos syndromes ehlersdanlos syndromes eds comprise a heterogeneous group of diseases of the connective tissue. The reported frequencies of angioid streaks in pseudoxanthoma elasticum vary tremendously with the era of the observer, the specialty dermatology, genetics, ophthalmology, etc. Etiology of choroidal neovascularization in young patients. These streaks can have a negative impact on vision due to choroidal neovascularization or choroidal rupture. Angioid streaks are present in 85% of patients with pxe. Lacquer cracks must be differentiated from 2 similar diseases of bruch membrane, namely angioid streaks and choroidal ruptures. The effects of angioid streaks are much more severe if the cracks extend into the center of the retina.
Angioid streaks are visible irregular cracklike dehiscences in bruchs membrane associated with atrophic degeneration of the overlying retinal pigmented epithelium. Angioid streaks are bilateral, narrow, irregular lines deep to the retina configured in a radiating fashion emanating from the optic disc, which result from breaks in a weakened bruchs membrane. The pathologies that we describe here are angioid streaks, optic nerve drusen, radiation retinopathy, idiopathic perifoveal telangiectasia, and lacquer cracks. Purposeto report the occurrence of a lacquer crack after photodynamic therapy pdt. Early diagnosis is important to lessen the severity of vision loss due to cnv membranes or trauma.
Pepsi asymptomatic, unless cnv develop signs peau dorange, on drusen. Ehlersdanlos syndrome, angioid streaks in springerlink. The diagnosis of angioid streaks is one that can usually be made clinically. Lacquer cracks are often mistaken for angioid streaks. At least 50% of all individuals with pxe demonstrate angioid streaks.
However, a large lacquer crack underlying a subretinal hemorrhage was formatted in the macula of the treated eye soon after pdt. Lacquer cracks are typical clinical findings in a highly myopic fundus and should alert the clinician to the possibility of retinal hemorrhage with or without cnvm. Degenerative myopia is an ocular disease characterized by excessive axial length, abnormal visual function, and several changes in the ocular tissues. Pathologic gaps in bruchs membrane, such as those that occur in angioid streaks, lacquer cracks, and choroidal ruptures, may persist indefinitely without being complicated by choroidal. Choroidal ruptures, similar distribution, color, and fluoresceinangiographic appearance to lc, but are caused by a traumaticevent. Angioid streaks are a rare ophthalmic condition with specific ophthalmoscopic features that are caused by many conditions. Introduction angioid streaks were first described by doyne in 1889. Jun 01, 2007 the pathologies that we describe here are angioid streaks, optic nerve drusen, radiation retinopathy, idiopathic perifoveal telangiectasia, and lacquer cracks. Angioid streaks usually emanate from the disc, tend to be straighter, and are reddish in color. We report an atypical case of suspected choroidal neovascularization associated with pseudoxanthoma elasticum. Lacquer cracks definition of lacquer cracks by medical. Individuals most commonly present with papules in the skin andor with angioid streaks of the retina found on routine eye examination or associated with retinal hemorrhage. Subretinal surgery for choroidal neovascularization in.
Improving differential diagnosis of angioid streaks. Bruchs membrane below the rpe, which is thickened, elevated and fractured. Oct scan of an angioid streak not of the same patient showing elevation and fracture of the rpe. Asim wasim slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
A 47yearold caucasian woman with pseudoxanthoma elasticum and angioid streaks was referred because of decreased and distorted vision in her right eye of one weeks duration. Result from cracklike breaks in weakened bruchs membrane peau dorange appearance that radiate out from the optic nerve. This will prevent the tip from getting clogged up with dried product. While you are using the 3d crystal lacquer, always let it rest tipside down in a container where you put damp towel on the bottom. Dec 11, 20 we report an atypical case of suspected choroidal neovascularization associated with pseudoxanthoma elasticum.
Lacquer cracks vs angioid streak vs choroidal rupture all three diseased statesof bruchs membrane angioid streaks emanate radially from disc, are straighter,and are reddish in color. Angioid streaks represent a rare ophthalmic condition that has very specific ophthalmoscopic features but is caused by different etiologies. If you continue browsing the site, you agree to the use of cookies on this website. Histolike spots in the mid treatment periphery and macular degeneration may occur. We describe the longterm effectiveness and tolerability of intravitreal vascular endothelial growth factor inhibitor ranibizumab in a patient with pseudoxanthoma elasticum with bilateral macular choroidal neovascularization secondary to angioid streaks. Angioid streaks conditionkeywords angioid streaks, choroidal neovascularization cnv photographer neha goel imaging device optical coherence tomography system rtvue description horizontal oct scan through the right macula. Associated with myopic degeneration, they are yellow streaks due to breaks in bruchs. Choroidal neovascularization cnv is the creation of new blood vessels in the choroid layer of the eye. Jul 22, 2019 only one half of patients with angioid streaks have a systemic association. Angioid streaks definition of angioid streaks by the free. Also break or absence of choriocapillaris beneath the angioid streaks as associations.
Retinal physician easily misdiagnosed retinal entities. Angioid streaks are evident in fundoscopy a few millimetres from the optic disc and rarely occur in the periphery of the posterior pole. Ophthalmology grand rounds suny downstate medical center. Patients with angioid streaks and traumatic choroidal ruptures. Angioid streaks breaks in a thickened or calcified bruch s membrane, reddishbrown curvilinear, radiations from on subretinal 50% associated with systemic disease, most commonly. Angioid streaks may be idiopathic or associated with pseudoxanthoma elasticum, ehlers danlos syndrome, sickle cell disease, acromegaly, pagets disease of the bone, and other diseases.
Lacquer crack formation after photodynamic therapy i. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Myopic cracks, angioid streaks, and traumatic tears in bruchs. Only one half of patients with angioid streaks have a systemic association. Angioid streaks are irregular, jagged, radiating lines that surround the optic disc and extend outward radially. If you have angioid streaks in one or both eyes, it is possible to remain asymptomatic and maintain perfect vision for a long time. Angioid streak may be associated with choroidal neovascularization cnv causing metamorphopsia andor visual decline. Choroidal ruptures, on the other hand, share with lacquer cracks similar distribution, color, and fluorescein angiographic appearance but are caused by a noticeable traumatic event. Color photographs were evaluated directly as were the component red and green channels. The features of eds were first described by hippocrates in. Nov 01, 2011 improving differential diagnosis of angioid streaks diagnostic considerations and a case study. The streaks intercommunicate in a ringlike fashion around the optic disc in 27% of cases and radiate outward in a tapering fashion from the peripapillary area in 73% of patients.
Angioid streaks are irregular, jagged, radiating lines that. Angioid streaks are seen in patients with pseudoxanthoma elasticum, a rare disorder of degeneration of the elastic fibers with tiny areas of calcification in the skin, retinae, and blood vessels, and they are visible during an examination using an ophthalmoscope. Angioid streaks definition of angioid streaks by the. In many cases, however, these fine cracks in the membrane expand, leading to visual impairment. Progressive symmetric vertical macular wide angioid streak. Angioid streaks were observed in 17 patients, 10 women 59% and 7 men, ranging in age from 29 to 49 years cohen et al. Only treatment for angioid streaks is to treat any cnv that may develop.
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