A 66-Year-Old Woman With Central Vision Loss

Ronald C Gentile, MD; Brooke Nesmith, MD

Disclosures

November 02, 2016

Paget disease of the bone, formerly known as osteitis deformans, is characterized by an accelerated rate of bone remodeling. The resultant overgrowth and impaired integrity of bone can lead to pain related to osteoarthritis or nerve impingement and fractures.[6] Complications associated with Paget disease include deafness, cranial nerve compression syndromes, and spinal stenosis.[7] Osteosarcoma is a rare complication.[7]

Angioid streaks do not have an adverse effect on visual function, as long as the overlying retinal layers remain intact. Thus, initially, patients should be closely watched. However, CNV that complicates angioid streaks can develop, leading to retinal hemorrhage and edema, and sometimes fibrotic retinal scaring and permanent vision loss.

Treatment for CNV secondary to angioid streaks is the same as current treatment for CNV secondary to exudative AMD. This initially consisted of laser photocoagulation or photodynamic therapy, but the current standard for CNV in exudative AMD, as well as for CNV secondary to angioid streaks, is anti-VEGF therapy, which has been shown to stabilize or improve visual acuity.[7] The purpose of treatment is to limit functional loss; these agents do not cure this chronically active disease.

The patient in this case was treated with monthly intravitreal anti-VEGF injections in both eyes, and resolution of retinal fluid and hemorrhage in both eyes was achieved. Vision in the right eye improved to 20/50, and in the left eye remained stable at 20/400.

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