A 58-year-old man presented with severe distortion of central vision that had begun a few weeks prior in his right eye. He previously had undergone laser treatment to the right macula and photodynamic therapy to the left macula for choroidal neovascularization secondary to pseudoxanthoma elasticum.
His uncorrected visual acuity was 20/400 on the right, and count fingers on the left. Slit-lamp examination was normal. Fundus examination showed temporal peau d’orange changes along with angioid streaks classic for pseudoxanthoma elasticum. There was a subretinal hemorrhage adjacent to the previous laser scar in the right eye and a disciform scar on the left. Fluorescein angiography and optical coherence tomography demonstrated a choroidal neovascular membrane on the right.
The patient declined further laser treatment. After discussion of the risks and benefits, he elected to proceed with an intravitreal Avastin (bevacizumab) injection in his right eye. This was carefully performed with attention to his intraocular pressure. Vision initially improved, but declined four months later. Another injection was given and his visual acuity improved to 20/80 (pinhole, 20/60) one month later.