gms | German Medical Science

Purpose: Angioid streaks represent an uncommon condition which predispose for choroidal neovascularizations (CNV). Possible treatment options include VEGF-inhibitors, PDT, laser photocoagulation or CNV extraction. As this is a rare entity randomized controlled trials for therapeutic interventions have not been performed and recommendations are based on case series. In this metaanalysis all published studies were analysed to allow for a better judgement on the efficacy of current therapeutic measures.

Methods: A systematic literature search was performed during February/ March 2012 using the Pubmed database. (Terms of search: angioid streaks, bevacizumab, ranibizumab, photodynamic therapy, laser photocoagulation, CNV extraction, natural history). Cited relevant literature of identified articles was also included. Primary outcome measure was change of best corrected visual acuity (BCVA).

Results: We identified 47 published studies. Treatment with VEGF inhibitors on average was found to improve or at least to stabilize BCVA in all case series. PDT resulted in a slowing of the disease progression and improvement of BCVA was only noted in few cases. Laser photocoagulation yielded comparable results to PDT but application was mostly restricted to extrafoveolar lesions and comlicated by frequent recurrences. Combination treatments showed similar results to monotherapies.

Conclusions: The results indicate that intravitreal VEGF inhibitors are currently the most efficacious treatment for CNV due to angioid streaks. PDT is obviously inferior as is laser photocoagulation, whereby the latter is also destructive with subsequent absolute scotoma. Combination treatments appear to have no advantage compared to monotherapy.