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  • Title: MULTIMODAL IMAGING OF FOCAL CHOROIDAL EXCAVATION COMPLICATED BY CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH ANGIOID STREAKS AND PSEUDOXANTHOMA ELASTICUM.
    Author: Ferreira BFA, Preti RC, Schmidt MB, Zacharias LC, Takahashi WY, Monteiro MLR.
    Journal: Retin Cases Brief Rep; 2021 Mar 01; 15(2):155-162. PubMed ID: 29965887.
    Abstract:
    PURPOSE: To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab. METHODS: Fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT angiography were performed in a 60-year-old white woman with angioid streaks and bilateral FCE. Spectral domain OCT images were taken before and after three-monthly intravitreal injections of bevacizumab. Histopathological analysis of the dermis established the diagnosis of pseudoxanthoma elasticum. RESULTS: Multimodal imaging revealed bilateral FCE and CNV. Spectral domain OCT diagnosed bilateral FCE and Type-1 and Type-2 CNV in the right eye, and irregular vascular network, along macular streak, in both eyes, which were not observed on fluorescein neither on indocyanine green angiography, but only on SD-OCT angiography. Patient presented good anatomical and functional response to intravitreal injections of bevacizumab. CONCLUSION: Focal choroidal excavation is a rare condition detected mainly by SD-OCT, which may be associated with angioid streaks secondary to pseudoxanthoma elasticum and complicated by CNV. Multimodal imaging is important for diagnosis and follow-up of such patients, even in the absence of signs of CNV, and anatomical and functional response to anti-vascular endothelial growth factor therapy is good.
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