Although uncommon, angioid streaks often have a systemic cause and. Lacquer cracks observed in peripheral fundus of eyes with high myopia mitsuki suga, kosei shinohara, kyoko ohnomatsui department of ophthalmology and visual science, tokyo medical and dental university, tokyo, japan abstract. Choroidal ruptures, similar distribution, color, and fluoresceinangiographic appearance to lc, but are caused by a traumaticevent. Documented preoperative imaging showed an absence of lacquer cracks in the eye that was operated on. Etiology angioid streaks result from cracklike breaks in bruchs membrane, which is abnormal in its structural composition, predisposing to these localized areas of rupture. Angioid streaks angioid streaks, also called knapp streaks or knapp striae are small breaks in bruchs membrane, an elastic tissue containing membrane of the retina that may become calcified and crack. Angioid streaks differential diagnoses medscape reference. If you continue browsing the site, you agree to the use of cookies on this website.
Progressive symmetric vertical macular wide angioid streak. Pdf progressive symmetric vertical macular wide angioid. Lacquer crack started in the right eye and became evident 1 year later in the left eye. Peripheral lacquer cracks as an early finding in pathological. Angioid streaks may be idiopathic in up to 50% of cases. Serial photography after repeated intravitreal injections of.
Angioid streaks are orange, red, grey or brown in color and can be confused for retinal blood vessels on superficial examination. Tiny breaks in the elastinfilled tissue in the retina in the back of the eye. Ivfa will show hyperfluorescence as the fluorescein leaks through bruchs membrane, highlighting these cracks. Lacquer cracks vs angioid streak vs choroidal rupture all three diseased statesof bruchs membrane angioid streaks emanate radially from disc, are straighter,and are reddish in color. Angioid streaks present as radial spokes emanating from the optic nerve head and seldom extend beyond the equator of the orbit. Angioid streaks are irregular, jagged, radiating lines that surround the optic disc and extend outward radially. Choroidal rupture is a break in the retinal pigment epithelium, bruchs membrane, and throughout the choroid following blunt trauma. The streaks run a convoluted course and tend to terminate abruptly. Patients with high myopia and lacquer cracks patients with angioid streaks and traumatic choroidal ruptures macular hole may develop in myopic eyes after lasik or photorefractive keratectomy. Angioid streaks knapp streaks statpearls ncbi bookshelf.
The cracks appear as thick, brown or grayish lines that radiate from the area around the optic nerve. Ophthalmology grand rounds suny downstate medical center. Lacquer cracks are spontaneous ruptures of the elastic lamina of bruchs membrane that appear yellowishwhite and are usually located in the posterior pole. The result are the lines seen in the picture called angioid steaks or lacquer cracks. In 1889, doyne first described angioid streaks in a patient with retinal hemorrhages secondary to trauma. Choroidal rupture is a break in the retinal pigment epithelium, bruchs membrane, and throughout the choroid following blunt. Introduction angioid streaks were first described by doyne in 1889. Macular degeneration, macular drusen, retinal pigment epithelial rpe stippling, macular oedema, choroidal neovascularisation cnv, angioid streaks, disciform scars, lacquer cracks, and myopia greater than 3. These images are pictures of the retina inside the back of the eye where the thin layer separating the retina and the tiny blood vessels underneath it has been compromised bruchs membrane. Clinicians must determine the presence of such etiologies, as well as address the ocular complications. If you have angioid streaks in one or both eyes, it is possible to remain asymptomatic and maintain perfect vision for a long time.
Angioid streaks usually emanate from the disc, tend to be straighter, and are reddish in color. Improving differential diagnosis of angioid streaks retinal physician. Radiating out from the optic disc in a fashion similar to the retinal vessels. All patients with angioid streaks of the ocular fundus who.
Angioid streaks are often associated with pseudoxanthoma elasticum, but have been found to occur in conjunction with other disorders, including pagets disease, sickle cell disease and ehlersdanlos syndrome. Lacquer cracks vs angioid streak vs choroidal rupture. In many cases, however, these fine cracks in the membrane expand, leading to visual impairment. Myopic lacquer cracks, angioid streaks, and traumatic tears have pathologic 540 american journal of ophthalmology april, 1987 fig. Full text lacquer cracks observed in peripheral fundus. Lacquer cracks have only been observed in the posterior pole of highly myopic eyes. They are caused by a breakdown in the collagen and elastic lamina of bruchs membrane.
Choroidal rupture is a break in the retinal pigment epithelium, bruchs membrane, and throughout. We report an unusual case of bilateral vertical lacquer crack with no history of ocular trauma and with progressive. Angioid streaks of macula 2016 2017 2018 2019 2020 billablespecific code h35. Pxe affects the retina through a dimpling of the bruch membrane. The streaks intercommunicate in a ringlike fashion around the optic disc in 27% of cases and radiate outward in a tapering fashion from the peripapillary area in 73% of patients. Angioid streaks usually present as linear gray or dark red lines with irregular serrated edges lying beneath normal retinal blood vessels.
Regarding autofluorescence, angioid streaks appear as fissures with central hypoautofluorescence and with a variable amount of hyperautofluorescence at the borders of the cracks figure 3. Bruchs membrane abnormalities in domeshaped and mushroom. Look toward the east border of the photo and notice the pebbly orange appearance of the retina. Progressive symmetric vertical macular wide angioid streaklike lacquer crack ahmad m mansour1,2 1department of ophthalmology, american university of beirut, 2department of ophthalmology, rafic hariri university hospital, beirut, lebanon purpose. Optic neuropathy and retinal complications after refractive surgery. Angioid streaks are evident in fundoscopy a few millimetres from the optic disc and rarely occur in the periphery of the posterior pole. Angioid streaks are a retinal condition characterized by breaks and cracks in bruchs membrane, the lower layer of the retina that helps feed and nourish the overlying photoreceptor layer. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Bruchs membrane can thicken, calcify and begin to crack. Choroidal ruptures, on the other hand, share with lacquer cracks. A 37yearold patient with bilateral high myopia who visited our clinic. The most likely diagnosis is angioid streaks associated with pseudoxanthoma elasticum. This photo shows the finding called peau dorange orange skin in the condition angioid streaks.
Angioid streaks have not been reported in newborns, and few cases have been described in individuals under 10 years of age. At least 50% of all individuals with pxe demonstrate angioid streaks. We studied the pattern of break formation in 60 eyes with myopic lacquer cracks, angioid streaks, or traumatic tears in bruchs. Key features narrow, jagged lines deep to the retina. Lacquer cracks are often mistaken for angioid streaks. The streaks emanating from the optic nerve in this case are evident. The effects of angioid streaks are much more severe if the cracks extend into the center of the retina. Myopic cracks, angioid streaks, and traumatic tears in. Angioid streaks usually do not extend past the equator. They were first described by robert walter doyne in 1889 in a patient with retinal hemorrhages. Angioid streaks and optic disc drusen in pseudoxanthoma. These streaks can have a negative impact on vision due to choroidal neovascularization or choroidal rupture.
Angioid streaks are seen in patients with pseudoxanthoma elasticum, a rare disorder of degeneration of the elastic fibers with tiny areas of calcification in the skin, retinae, and blood vessels, and they are visible during an examination using an ophthalmoscope. Angioid streaks biopsy of papular lesion on the neck was positive for pseudoxanthoma elasticum. Unlike other similar presentations such as lacquer cracks, they dont radiate from the center of the posterior pole. Lacquer cracks must be differentiated from 2 similar diseases of bruch membrane, namely angioid streaks and choroidal ruptures. Vander definition irregular, jagged breaks in an abnormal, calcified bruchs membrane. Patients with angioid streaks have an increased risk of developing hemorrhages associated with trauma because of the rupture of the choroid. Clinicians should always be on the lookout for conditions that can mimic angioid streaks. The reported frequencies of angioid streaks in pseudoxanthoma elasticum vary tremendously with the era of the observer, the specialty dermatology, genetics, ophthalmology, etc. Improving differential diagnosis of angioid streaks. Later in 1892, knapp named them angioid streaks because of their resemblance to. Asim wasim slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Three diseases that involve bruchs membrane give somewhat similar fundus appearance in different clinical settings. Hi doctor, my eye doctor found small lacquer cracks near the center of my right eye. In 1889, doyne first described angioid streaks in a patient with retinal hemorrhages secondary to.
Learn more about angioid streaks from related diseases, pathways, genes and ptms with the novus bioinformatics tool. Also break or absence of choriocapillaris beneath the angioid streaks as associations. Angioid streaks is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. Retinal physician easily misdiagnosed retinal entities. Idiopathic angioid streaks in a 39yearold emmetropic man. Although angioid streaks can be idiopathic, there is often an underlying cause, which the driving force when managing these patients. Other associated findings in patients with angioid streaks may include peau dorange or leopardskin spotting, consisting of speckled yellowish mottling of the posterior pole mostly apparent in the temporal macula. Angioid streaks, clinical course, complications, and.
Look for lacquer cracks in high myopes for early warning. Progressive symmetric vertical macular wide angioid streaklike. Angioid streaks are visible irregular cracklike dehiscences in bruchs membrane associated with atrophic degeneration of the overlying retinal pigmented epithelium. The differential diagnosis includes agerelated macular degeneration, choroidal sclerosis, myopic lacquer cracks, traumatic hemorrhage, and choroidal rupture. Angioid streaks are breaks in the degenerated and mineralized. Myopic cracks, angioid streaks, and traumatic tears in bruchs.
Angioid streaks and optic disc drusen in pseudoxanthoma elasticum. Angioid streaks harvard catalyst profiles harvard catalyst. Top left, visual acuity was 2030 in the right eye, in spite of the dense spiderweb streak configuration top right. There are a number of potential causes of angioid streaks, including pseudoxanthoma elasticum, ehlerdanlos syndrome, pagets disease, sickle cell disease, and other hemoglobinopathies paton, 1972. We report a case with lacquer cracks observed in the peripheral fundus. Angioid streaks are bilateral, narrow, irregular lines deep to the retina configured in a. Angioid streaks are bilateral blood vessellike cracks emanating from the optic nerve. They are also called knapps striae as he first coined the term in 1892 because of their marked resemblance to blood vessels.
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