A 43-year-old woman presented with progressive loss of visual acuity in her left eye.
The patient had been diagnosed with angioid striae five years earlier.
In the exploration, the goal was to achieve a visual acuity of two meters away from the right eyebrow and «sing fingers» unit to the left eye.
Eye tension and biomycosis were within normal limits.
Colonoscopy under dilation showed, in both eyes, the existence of serpent radial lesions to the optic disc extending towards the periphery.
In addition, the left eye showed a large mobilizing destructive lesion of pigment and fibrosis covering the entire macular area.
Fluorescein angiography (FFA) was performed with the following results: in the right eye hypo and hyperfluorescent lines were observed with macular pigment mobilization without contrast diffusion.
In the left eye the same linear lesions were observed accompanied by a hypo- and hyperfluorescent area at macular level without contrast diffusion in late times being the diagnosis compatible with bilateral subretinal angioid streaks and neovascular membrane uncomplicated.
Periodic clinical follow-up was advised.
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Two months later the patient came complaining of worsening of visual acuity, this time in the right eye.
The exploration revealed a visual acuity of two meters in the left eye due to difficulty in the right eye and «digesting».
Funduscopically, in the right eye, a small hemorrhage and posterior pole pigment mobilization were observed, with striae aquinas, already present in previous examinations.
A new FFA of the right eye revealed a macular hyperfluorescence from the initial times surrounded by a hypofluorescent halo with an increase in fluorescence towards late times and minimal neovascular diffusion, not previously observed.
A new diagnosis was established, complicated angioid streaks with subfoveal neovascular membrane in the right eye.
Treatment with PDT was proposed and after the first session there was partial resorption of bleeding with maintenance of central pigmentation.
These findings were confirmed with AGF, which revealed a slight contrast diffusion in late times.
Therefore, despite visual recovery, it was decided to apply two more PDT sessions.
In the last review, the visual acuity remained in the unit and angiographically, a hypo- and hyperfluorofluorescent lesion compatible with a degenerative lesion in the macular area was observed.
In mean angiographic times, there was an increase in hyperfluorescence that was maintained in late times, but without contrast diffusion.
