A 64-year-old woman from Africa presented with worsening vision of several years’ duration. Visual acuity was 20/60 in the right eye and hand motion in the left. Slit-lamp exam was normal other than 1+ nuclear sclerosis in each eye. On fundus examination, she was noted to have classic-appearing angioid streaks with crystalline spots (inferiorly), retinal pigment epithelial atrophy (peripapillary), and choroidal neovascularization (macula).
Fluorescein angiography demonstrated radiating lines from the optic nerve up to the midperiphery of the retina with hyperfluorescent edges consistent with angioid streaks. A central area of hyperfluorescence was increasing in size and intensity with time, indicating the presence of a choroidal neovascular membrane. The patient was treated with bevacizumab and was referred to a dermatologist who confirmed a diagnosis of pseudoxanthoma elasticum.
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