Case of angioid streaks treated with multiple different anti-vascular endothelial growth factor injection

Doyne was descripted angioid streaks (AS) in 1889 as spider-like irregular, bilateral, dark red to gray lines under the retina around optic disk.1 Histopathological studies showed that AS represents breaks and crack-like dehiscences in calcified, thickened both collagenous and elastic part of Bruch membrane. Both atrophy and hyperplasia were developed in retinal pigment epithelium (RPE) and destruction of choriocapillary layers were occurred.2 Diagnosis of AS is based on presence of the classical clinical appearance on fundus evaluation and optical coherence tomography (OCT). In fundus fluorescein angiography (FFA) hyperfluorescence were observed over the breaks due to RPE atrophy and hypofluorescence associated with RPE hyperplasia. Complications of AS such as choroidal neovascular membrane (CNV), subretinal hemorrhage and pigment epithelial detachment (PED) may cause legal blindness, especially in middleaged patients. While, laser photocoagulation, macular translocation surgery, transpupillary thermotherapy and photodynamic therapy were used to applied in treatment of AS patients with visual loss in last decades, intravitreal anti-vascular endothelial growth factor (VEGF) injection is the most effective and current treatment method for CNV due to AS.3–7 In this case report, we presented an AS with visual loss in one eye due to CNV which is followed-up 6-year and treated with multiple different anti-VEGF injection. We aimed to show the risk factor of developing CNV in case with AS, the long-term results of different anti-VEGF therapies, the superiority of them from each other and the effectiveness of switch therapy.