Fundus Photography of Traumatic Choroid Rupture with Angioid Streaks
Title: Fundus Photography of Traumatic Choroid Rupture with Angioid Streaks
Author: Alaina Hamilton, B.S.
Photographer: James Gilman, CRA, FOPS
Date: June 2004 (image 1) and October 2013 (image 2)
Image or video:
Keywords/Main Subjects: Angioid Streaks; Traumatic Choroid Rupture;
Secondary CORE Category:
Diagnosis: Traumatic Choroid Rupture with Angioid Streaks
Description of Image:
The fundus photos shown are from a middle-age man with pseudoxanthoma elasticum and angioid streaks that presented to the clinic a month after he was struck as a pedestrian by a motor vehicle. The first image shows his right eye before the accident and the second image was taken a month after the accident. The image taken before the accident demonstrates peau d’orange (arrow), which is the pebbly orange appearance to the retina and a classic finding seen with angioid streaks. On exam after the accident, he was found to have traumatic choroid rupture and extensive subretinal hemorrhage in both eyes, the left worse than the right. His vision after the accident was found to be 20/70 in the right eye and count fingers in the left (prior to the accident he had 20/20 vision in both eyes). A couple of months after this visit, he returned to clinic where his vision had improved to 20/25 in the right eye and 20/40. However, he was found to have developed a choroidal neovascular membrane in the left eye so he was treated with intravitreal anti-VEGF at that time. His vision in his left eye improved to 20/25 with the treatment and he is still currently stable with the monthly anti-VEGF injections.
Angioid streaks are bilateral, irregular tapering lines that lie deep to the retina and radiate from the peripapillary region within the posterior pole. Later ingrowth of fibrovascular tissue from the choroid into the sub-retinal pigment epithelial space can partially or totally obscure the streaks margins. The streaks represent breaks in a weakened Bruch’s membrane. These breaks can occur spontaneously or may be the result of even mild trauma. Other complications that can arise include choroidal neovascularization and subretinal hemorrhage. Approximately 50% of patients with angioid streaks have an associated systemic disease, pseudoxanthoma elasticum being the most common. Other commonly associated diseases can be remembered with the mnemonic PEPSI: Pseudoxanthoma elasticum, Ehler-Danlos syndrome, Paget’s disease of bone, Sickle cell disease, and Idiopathic, although there are many other less common associations. Diagnosis is usually made by clinical examination alone but can be confirmed with fluorescein angiography. Fluorescein angiography is particularly useful in evaluating choroidal neovascularization, as this would warrant treatment. Intravitreal anti-VEGF therapy can be used to stabilize vision if CNV has occurred, but often requires repeated injections due to recurrence.
Mathew R, Sivaprasad S, Augsburger JJ, Corrêa ZM. Retina. Vaughan & Asbury’s General Ophthalmology, 19e New York, NY: McGraw-Hill
Georgalas I, Papaconstantinou D, Koutsandrea C, et al. Angioid streaks, clinical course, complications, and current therapeutic management. Therapeutics and Clinical Risk Management. 2009;5:81-89.
Faculty Approval by: P.S. Bernstein, MD, PhD
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Disclosure (Financial or other): None