Choroidal neovascularization in a case of angioid streaks

A 21 year old male patient reported in 2003 with complaint of diminution of vision in left eye since 1 month. Best corrected visual acuity OD was 20/20 and 20/120 OS. Fundus evaluation revealed angioid streaks in both eyes with scarred Choroidal neovascularization (CNV) in left eye [Fig. 1]. He was followed up regularly at intervals of 3 months. In 2010, he noticed blurring of vision in the right eye. BCVA was 20/30 OD. Fundus examination revealed presence of CNV which was confirmed on OCT [Fig. 2]. He was administered 3 intravitreal injections (IVT) of ranibizumab at intervals of 1 month each following which the lesion resolved and the visual acuity in right eye improved to 20/20 [Fig. 3]. One year later, the patient again experienced metamorphopsia with drop of BCVA to 20/30 OD. On examination the lesion appeared same as the previous follow‐up and the OCT also did not suggest any fresh activity. However the fluorescein angiography revealed leakage nasal to the fovea suggestive of a recurrence from the CNV [Fig. 4]. This was treated successfully with 2 injections of ranibizumab, with the patient maintaining 20/20 OD for a period of 1 year on the last follow‐up [Fig. 5].