Sir,
We thank Diago1 for the interest shown in our recent article. We reported for the first time the use of intravitreal aflibercept as primary treatment for choroidal neovascularisation (CNV) in angioid streaks (AS) using a pro re nata regimen.2 This approach, in which treatment is withheld unless there is CNV activity, has been the most widely adopted in this setting.3, 4
Treat and extend (T&E) is a treatment modality that aims to treat the CNV proactively, in order to find an optimal treatment interval, and has been more commonly used in the context of neovascular age-related macular degeneration (nAMD). While we find the T&E modality to be an interesting approach for AS-associated CNV, we agree with previous reports that the CNV in this context is closer to myopia-related CNV than nAMD-related CNV, and therefore may require fewer injections.4 Additionally, patients can be activity-free for several years, or develop new CNV lesions in a different location altogether, making it difficult to identify a specific pattern of recurrence.4 This could lead to overtreatment with subsequent increase of associated risks such as chorioretinal atrophy.5
Even though larger prospective trials are needed to elucidate on the best treatment protocol, they are difficult to arrange due to the rarity of the condition.
References
Diago T . Treat and extend regimen with aflibercept for choroidal neovascularization in angioid streaks. Eye (Lond) 2016; 30: 637–639.
Vaz-Pereira S, Collaço L, De Salvo G, van Zeller P . Intravitreal aflibercept for choroidal neovascularisation in angioid streaks. Eye (Lond) 2015; 29: 1236–1238.
Gliem M, Finger RP, Fimmers R, Brinkmann CK, Holz FG, Charbel Issa P . Treatment of choroidal neovascularization due to angioid streaks: a comprehensive review. Retina 2013; 33: 1300–1314.
Tilleul J, Mimoun G, Querques G, Puche N, Zerbib J, Lalloum F et al. Intravitreal ranibizumab for choroidal neovascularization in angioid streaks: four-year follow-up. Retina 2015 e-pub ahead of print 9 September 2015.
Grunwald JE, Daniel E, Huang J, Ying GS, Maguire MG, Toth CA et alCATT Research Group. Risk of geographic atrophy in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2014; 121: 150–161.
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Dr Vaz-Pereira has received consultant fees from Bayer and Novartis and has received travel grants from Bayer, Novartis, Alcon, Allergan and Alimera Sciences. Dr Collaço has received travel grants from Bayer. Dr De Salvo has received travel grants from Bayer and Heidelberg Engineering. Dr van Zeller declares no conflict of interest.
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Vaz-Pereira, S., Collaço, L., De Salvo, G. et al. Intravitreal aflibercept for choroidal neovascularisation in angioid streaks. Eye 30, 639 (2016). https://doi.org/10.1038/eye.2015.284
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DOI: https://doi.org/10.1038/eye.2015.284