Vitreous and Retina

Angioid Streaks

Angioid streaks demonstrating irregular concentric and some fine radial streaks associated with interconnected circular breaks near the optic disc. Peau d'orange pattern of RPE is also noted in the temporal midperiphery.
  • Linear cracks in a thickened Bruch's membrane.
  • Occurs bilaterally, but asymmetric

Clinical Features

  • Symptoms: usually asymptomatic, but may affect vision over time due to progression of streaks towards the fovea
  • Signs:
    • Irregular, spokelike, curvilinear or jagged streaks that radiate outward from the peripapillary area towards the peripheral fundus or can be concentric to the optic disc
    • Near the optic disc, they may be interconnected by circular breaks
    • Color varies from reddish orange to dark brown, or appear grayish if fibrovascular tissue is present
  • Associated funduscopic findings may include:
    • Peau d'orange (orange skin) pattern of diffuse mottling of the pigment epithelium in the temporal midperiphery
    • Peripheral subretinal crystalline bodies
    • Focal atrophic spots
    • Optic nerve drusen
  • Fluorescein angiographic findings:
    • Irregular hyperfluorescence of the streaks during early phases and late staining
    • Can be seen as hypofluorescence of the streaks outlined by hyperfluorescence margins, which stain in the late phases
    • Some clinically invisible streaks may be observed during fluorescein angiography
  • Most common associated systemic conditions:
    • Idiopathic
    • Pseudoxanthoma elasticum (PXE)
    • Paget's disease
    • Sickle cell disease
    • Ehler's- Danlos Syndrome

Complications

  • Choroidal neovascularization
  • High risk of severe subretinal hemorrhages due to rupture of the Bruch's membrane following a relatively mild ocular injury
  • Management: laser photocoagulation in selected cases of choroidal neovascularization, but the recurrence rate is high.