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A Comprehensive Review From Pathophysiology to Treatment

Chatziralli, Irini, MD, MSc, PhD, FEBO; Saitakis, George, MD, MSc, FEBO; Dimitriou, Eleni, MD; Chatzirallis, Alexandros, MD; Stoungioti, Sofia, MD; Theodossiadis, George, MD, PhD; Theodossiadis, Panagiotis, MD, PhD

doi: 10.1097/IAE.0000000000002327

Purpose: To stratify the literature on angioid streaks, from pathophysiology to treatment.

Methods: Review of the current literature.

Results: Angioid streaks are crack-like dehiscences of Bruch membrane, which may coexist with systemic diseases, such as pseudoxanthoma elasticum, Paget disease, Ehlers–Danlos syndrome, hemoglobinopathies, or other diseases of the collagen. Various diagnostic methods, including infrared and red-free retinography, autofluorescence, optical coherence tomography, fluorescein angiography, and indocyanine green angiography, are useful to diagnose, evaluate, and monitor angioid streaks. Choroidal neovascularization consists of a major complication of angioid streaks leading to visual impairment. Therefore, observation could not be a treatment option. Photodynamic treatment or anti–vascular endothelial growth factor agents have been used for the treatment of angioid streaks, offering promising but short-term results. Currently, the available treatment may limit the disease, but not permanently inactivate it.

Conclusion: This review discusses the epidemiology, pathophysiology, diagnosis, and treatment of angioid streaks, presenting the existing literature on this topic.

This review makes an update of the literature regarding angioid streaks, giving emphasis to epidemiology, pathophysiology, histology, clinical characteristics, imaging, and potential treatment modalities.

2nd Department of Ophthalmology, University of Athens, Athens, Greece.

Reprint requests: Irini Chatziralli, MD, MSc, PhD, FEBO, 28, Papanastasiou Street, Agios Dimitrios, 17342 Athens, Greece; e-mail:

None of the authors has any financial/conflicting interests to disclose.

I. Chatziralli and G. Saitakis have equal contribution to the manuscript.

© 2019 by Ophthalmic Communications Society, Inc.