Angioid streaks

An overview of angioid streaks in the context of medical education

Angioid Streaks

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Diagram of Bruch's membrane, where angioid streaks occur.

Angioid streaks are irregular, jagged lines that radiate from the optic disc in the fundus of the eye. They are associated with breaks in Bruch's membrane, a vital layer of the eye that supports the retina. These streaks are often seen in association with various systemic conditions and can lead to significant visual impairment if not properly managed.

Pathophysiology

Angioid streaks result from the calcification and subsequent cracking of Bruch's membrane. This process can compromise the structural integrity of the retina, leading to potential complications such as choroidal neovascularization. The streaks themselves appear as dark, reddish-brown lines and are often bilateral.

Associated Conditions

Several systemic diseases are known to be associated with angioid streaks, including:

• Pseudoxanthoma elasticum
• Ehlers-Danlos syndrome
• Paget's disease of bone
• Sickle cell disease

These conditions can affect the connective tissue and lead to the characteristic changes seen in Bruch's membrane.

Clinical Presentation

Patients with angioid streaks may be asymptomatic initially. However, as the condition progresses, they may experience:

• Decreased visual acuity
• Metamorphopsia (distorted vision)
• Central vision loss if choroidal neovascularization occurs

Diagnosis

The diagnosis of angioid streaks is primarily clinical, based on fundoscopic examination. Imaging techniques such as optical coherence tomography (OCT) and fluorescein angiography can be used to assess the extent of the streaks and any associated complications.

Management

There is no specific treatment for angioid streaks themselves. Management focuses on monitoring for complications such as choroidal neovascularization, which can be treated with anti-VEGF (vascular endothelial growth factor) therapy. Regular follow-up with an ophthalmologist is essential for patients with angioid streaks.

Prognosis

The prognosis for patients with angioid streaks varies depending on the presence and management of associated complications. Early detection and treatment of choroidal neovascularization can help preserve vision.

Related pages

• Bruch's membrane
• Pseudoxanthoma elasticum
• Choroidal neovascularization