Sir,

Choroidal neovascularization (CNV) secondary to angioid streaks (AS) is a cause of important vision loss. The use of antivascular endothelial growth factors to treat CNV due to AS is well described. Until now, only experience with bevacizumab and ranibizumab had been reported to be an effective option of treatment.1 Recently, Vaz-Pereira et al reported in Eye the first two cases of CNV due to AS in which intravitreal aflibercept was used as primary treatment with pro re nata (PRN) regimen.2 We suggest the option of treat and extend regimen for this type of cases. We present the first case of CNV in AS in which intravitreal aflibercept was used following a treat and extend regimen with a follow-up period of 1 year.

Case report

A 60-year-old woman came to the emergency room with metamorphopsia in her left eye (LE). She had the medical antecedent of CNV secondary to AS in her right eye (RE) treated with 11 intravitreal injections of bevacizumab following a PRN regimen and a bad evolution. A complete ophthalmic examination was done. Her best corrected visual acuity (BCVA) was 20/200 in RE and 20/25 in LE. The anterior pole did not show any abnormality. The intraocular pressure was 15 and 17 mmHg, respectively. Funduscopy showed a disciform membrane in RE and AS in both eyes. Optical coherence tomography (OCT) revealed subretinal fibrosis with distortion of the foveal anatomy in RE and an incipient CNV in LE (Figure 1) confirmed by fluorescein angiography. Intravitreal aflibercept was injected in LE, one injection a month during 3 months. BCVA in LE improved to 20/20 and also OCT. After the good response in LE and bad evolution in RE, a treat and extend regimen was followed in LE. After 1-year period of follow-up, the BCVA is 20/20 in LE with no activity of CNV after six intravitreal aflibercept injections (Figure 2).

Figure 1
figure 1

Funduscopy of RE and LE in which AS can be observed; macular OCT of RE and LE at the moment of the diagnosis of incipient CNV in LE.

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Figure 2
figure 2

Retinography with macular OCT of LE after 12 months of treatment with intravitreal aflibercept following a treat and extend regimen.

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Comment

The use of intravitreal aflibercept in a treat and extend regimen may be a good option for the management of CNV due to AS. Further prospective studies on a larger number of patients are required.