Long-Term Follow-Up of Polypoidal Choroidal Vasculopathy Secondary to Angioid Streaks Treated by Intravitreal Aflibercept and Ranibizumab

Purpose: Angioid streaks (AS) are dehiscences in Bruch’s membrane that may be idiopathic or associated with numerous systemic illnesses. Polypoidal choroidal vasculopathy (PCV) is an underdiagnosed exudative chorioretinopathy often characterised by serosanguineous detachments of the pigmented epithelium. The use of the anti-VEGF agents ranibizumab and aflibercept in the management of PCV secondary to AS has not been previously documented. We report 3 patients with active PCV secondary to AS, 1 of which had a family history of PCV secondary to AS, not previously reported in the literature. All patients were symptomatic and treated with intravitreal anti-VEGF therapy with and without combination photodynamic therapy (PDT). Methods: This is a long-term retrospective case review of 3 eyes of 3 patients with AS and clinical features of PCV. The patients were examined using fundoscopy, spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All patients were managed with intravitreal anti-VEGF using a treat-and-extend protocol according to specific retreatment criteria. One patient had 1 session of PDT in combination with anti-VEGF injections. Results: The mean follow-up time in all patients was 4 years. In all 3 cases, the treatment resulted in improved visual acuity and regression of active PCV lesions with a longer duration between injections. Conclusion: The treat-and-extend protocol with intravitreal aflibercept or ranibizumab with or without PDT is effective and safe for PCV secondary to AS.