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Therapy of Pseudoxanthoma Elasticum: Current Knowledge and Future Perspectives. Biomedicines 2021; 9:biomedicines9121895. [PMID: 34944710 PMCID: PMC8698611 DOI: 10.3390/biomedicines9121895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with an estimated prevalence of between 1 per 25,000 and 56,000. Its main hallmarks are characteristic skin lesions, development of choroidal neovascularization, and early-onset arterial calcification accompanied by a severe reduction in quality-of-life. Underlying the pathology are recessively transmitted pathogenic variants of the ABCC6 gene, which results in a deficiency of ABCC6 protein. This results in reduced levels of peripheral pyrophosphate, a strong inhibitor of peripheral calcification, but also dysregulation of blood lipids. Although various treatment options have emerged during the last 20 years, many are either already outdated or not yet ready to be applied generally. Clinical physicians often are left stranded while patients suffer from the consequences of outdated therapies, or feel unrecognized by their attending doctors who may feel uncertain about using new therapeutic approaches or not even know about them. In this review, we summarize the broad spectrum of treatment options for PXE, focusing on currently available clinical options, the latest research and development, and future perspectives.
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Chen L, Kim IK, Lane AM, Gauthier D, Munzenrider JE, Gragoudas ES, Miller JW. Proton beam irradiation for non-AMD CNV: 2-year results of a randomised clinical trial. Br J Ophthalmol 2014; 98:1212-7. [DOI: 10.1136/bjophthalmol-2013-304761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Orssaud C, Roche O, Dufier JL, Germain DP. Visual Impairment in Pseudoxanthoma Elasticum: A Survey of 40 Patients. Ophthalmic Genet 2014; 36:327-32. [PMID: 24749718 DOI: 10.3109/13816810.2014.886268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pseudoxanthoma elasticum is an inherited disorder of connective tissue characterized, among other symptoms, by impaired vision. OBJECTIVE To evaluate the nature and age of onset of ophthalmologic manifestations in pseudoxanthoma elasticum. PATIENTS AND METHODS Forty consecutive patients affected with pseudoxanthoma elasticum underwent measurements of their refractive error and visual acuity, together with slit-lamp examination. RESULTS The mean age of the patients (8 M, 32 F) was 43.35 years. Fifty-seven eyes (33 patients, mean age: 40.75 years) had a BCVA >20/50 whereas 23 eyes in 16 patients (mean age: 53.31 years) had ≤20/50. Seven patients (17.50%), all but one over 52 years old, were visually disabled. BCVA ≤20/50 in at least one eye was observed in 73.33% of patients of 52 years old or older and in 20.00% of patients younger than 52, respectively. Angioid streaks were observed in 75 eyes (93.75%) and extended toward the macula in 51 eyes from 29 patients. Macular involvement was observed for the first time at a mean age of 44.28 years. Neovascularization was observed in 28 eyes (17 patients; mean age: 51.70 years), all with poor BCVA. CONCLUSION Macular choroidal neovascularization is frequent in pseudoxanthoma elasticum, and accounts for the poor ophthalmologic natural history of the disease. Patients should be advised to self-monitor their visual acuity using the Amsler grid. The frequency of choroidal neovascularization appears age-dependent, suggesting that bi-yearly fundus examination is appropriate in young patients whereas patients older than 40 should be examined twice a year.
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Affiliation(s)
- Christophe Orssaud
- a Referral Center for Rare Ophthalmological Diseases, Department of Ophthalmology, Hopital Europeen Georges Pompidou, AP-HP , Paris , France
| | - Olivier Roche
- b Department of Ophthalmology , University Paris Descartes , Paris , France
| | - Jean-Louis Dufier
- a Referral Center for Rare Ophthalmological Diseases, Department of Ophthalmology, Hopital Europeen Georges Pompidou, AP-HP , Paris , France .,b Department of Ophthalmology , University Paris Descartes , Paris , France
| | - Dominique P Germain
- c Referral Center for Inherited Disorders of Connective Tissue, Division of Medical Genetics, Department of Paediatrics, CHU Raymond Poincare (AP-HP) , Garches , France , and.,d Department of Medical Genetics , UFR des sciences de la sante Simone Veil, University of Versailles -- St Quentin en Yvelines , Montigny , France
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Abstract
PURPOSE To evaluate different therapies for choroidal neovascularization (CNV) due to angioid streaks (AS). METHODS Studies were identified by a systematic literature search and were included in the analysis based on predefined criteria. Primary outcome measure was change in best-corrected visual acuity (BCVA). RESULTS Fifty-four relevant studies were identified and included mostly uncontrolled case series. No randomized controlled trials were available. Treatment with vascular endothelial growth factor inhibitors improved or stabilized BCVA in all case series. Photodynamic therapy slowed down disease progression with stabilization or decrease of BCVA. Individual BCVA and follow-up data for each treated eye were reported in >160 cases for both treatments, vascular endothelial growth factor inhibitors and photodynamic therapy. In a pooled analysis of those studies, the difference of mean change in BCVA between both treatment groups was estimated as approximately 6 lines (0.59 logMAR [95% confidence interval, 0.38-0.8; P < 0.0001]). A better baseline BCVA was associated with a better BCVA outcome (P < 0.0001). Laser photocoagulation yielded comparable results as photodynamic therapy but application was mostly restricted to extrafoveal lesions, was complicated by frequent recurrences, and led to more retinal damage with subsequent absolute scotomas. Combination therapies seem to be not superior to monotherapy. CONCLUSION Intravitreal vascular endothelial growth factor inhibitors are currently the most effective treatment of CNV due to angioid streaks.
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Barbazetto IA, Takahashi BS. Verteporfin photodynamic therapy in the age of antiangiogenic therapy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.4.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY VERSUS COMBINATION TREATMENT WITH PHOTODYNAMIC THERAPY FOR SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO CAUSES OTHER THAN AGE-RELATED MACULAR DEGENERATION. Retina 2011; 31:2078-83. [DOI: 10.1097/iae.0b013e3182109074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cekiç O, Göçmez E, Kocabora MS. Management of CNV in angioid streaks by intravitreal use of specific anti-VEGF165 Aptamer (pegaptanib sodium): long-term results. Curr Eye Res 2011; 36:492-5. [PMID: 21501082 DOI: 10.3109/02713683.2011.560409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the effectiveness of intravitreal pegaptanib sodium injection in patients with choroidal neovascularization (CNV) secondary to angioid streaks. METHODS Five eyes of four patients with angioid streaks with CNV underwent uneventful intravitreal injection of pegaptanib sodium (0.3 mg/90 µL). Patients were followed up with Snellen visual acuity testing, optical coherence tomography, and fundus fluorescein angiography. RESULTS The median follow-up time was 18 months (range: 15 to 24 months). Visual acuity improved in two eyes, and stabilized in three out of five eyes. At final examination, CNV regressed with resolution of subretinal fluid in all but one patient with bilateral CNV from angioid streaks. CONCLUSION Intravitreal pegaptanib sodium for CNV associated with angioid streaks led to inactivation of most of the CNV lesions, stabilizing or improving visual acuity in all eyes.
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Affiliation(s)
- Osman Cekiç
- Department of Ophthalmology, Vakıf Gureba Training and Research Hospital, İstanbul, Turkey.
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Mimoun G, Tilleul J, Leys A, Coscas G, Soubrane G, Souied EH. Intravitreal ranibizumab for choroidal neovascularization in angioid streaks. Am J Ophthalmol 2010; 150:692-700.e1. [PMID: 20719301 DOI: 10.1016/j.ajo.2010.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 05/30/2010] [Accepted: 06/02/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze retrospectively the efficacy of intravitreal ranibizumab injections for the management of choroidal neovascularization (CNV) in patients with angioid streaks. DESIGN Nonrandomized, double-center, retrospective, interventional case series. METHODS A consecutive series of patients affected with CNV associated with angioid streaks were treated with intravitreal ranibizumab injections (0.5 mg/0.05 mL). Best-corrected visual acuity, fundus photography results, optical coherence tomography (OCT) results, and fluorescein angiography results were examined before and after treatment. The primary end point was the percentage of eyes with stable or improved visual acuity at the end of follow-up. Secondary end points were the percentage of eyes with stable or decreased macular thickness on optical coherence tomography and the percentage of eyes with persistent leakage on fluorescein angiography at the last follow-up examination. RESULTS Thirty-five eyes of 27 patients were treated with repeated intravitreal ranibizumab injections (mean, 5.7 injections; range, 2 to 14 injections) for a mean of 24.1 months (range, 6 to 37 months). At the end of follow-up, visual acuity was stabilized or improved in 30 (85.7%) of 35 eyes. Macular thickness had stabilized or decreased in 18 (51.5%) of 35 eyes. At the last follow-up examination, on fluorescein angiography, no further leakage was observed in 23 (65.7%) of 35 eyes. CONCLUSIONS In this large series of angioid streaks-associated CNV, ranibizumab injections allowed stabilization of visual acuity. Ranibizumab seems to be a safe therapeutic option in CNV associated with angioid streaks.
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Affiliation(s)
- Gerard Mimoun
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, University of Paris XII Henri Mondor, France
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LONG-TERM OUTCOMES OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION IN PSEUDOXANTHOMA ELASTICUM. Retina 2010; 30:748-55. [DOI: 10.1097/iae.0b013e3181c596b1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Chan WM, Lim TH, Pece A, Silva R, Yoshimura N. Verteporfin PDT for non-standard indications--a review of current literature. Graefes Arch Clin Exp Ophthalmol 2010; 248:613-26. [PMID: 20162298 DOI: 10.1007/s00417-010-1307-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 12/17/2009] [Accepted: 01/14/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Verteporfin photodynamic therapy (PDT) is approved for the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), as well as for subfoveal CNV due to pathologic myopia and ocular histoplasmosis syndrome. Verteporfin PDT addresses the underlying pathology of ocular vascular disorders through its angio-occlusive mechanism of action, which reduces both visual acuity loss and the underlying leakage associated with lesions. Verteporfin PDT has also been associated with encouraging treatment outcomes in case studies involving patients with choroidal vascular disorders such as polypoidal choroidal vasculopathy, central serous chorioretinopathy, choroidal haemangioma, angioid streaks, and inflammatory CNV, i.e. conditions currently considered as non-standard indications of verteporfin PDT. In many studies, outcomes were better than expected based on the natural courses of each of these conditions. Although the anti-vascular endothelial growth factor (VEGF) therapies, ranibizumab and pegaptanib, have been approved for CNV due to AMD, their role in these other choroidal vascular disorders remains to be established. We summarize current literature that has documented the use of verteporfin PDT in these conditions. CONCLUSIONS The complex pathogenesis of CNV provides a rationale for investigating combination approaches comprising verteporfin PDT and anti-VEGF therapies. Randomized controlled studies are warranted to confirm the preliminary results of verteporfin PDT as a monotherapy or in combination with anti-VEGF therapies in the treatment of a variety of choroidal vascular conditions.
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Affiliation(s)
- Wai Man Chan
- Department of Ophthalmology, HK Sanatorium Hospital, Happy Valley, Hong Kong
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Lee JM, Nam WH, Kim HK. Photodynamic therapy with verteporfin for choroidal neovascularization in patients with angioid streaks. KOREAN JOURNAL OF OPHTHALMOLOGY 2007; 21:142-5. [PMID: 17804918 PMCID: PMC2629678 DOI: 10.3341/kjo.2007.21.3.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks. Methods The authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size. Results Their mean age was 61.3±5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5±10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400±766.81 µm, and the mean GLD at the last examination was 3483±444.59 µm. Conclusions PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.
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Affiliation(s)
- Jun Mok Lee
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Bhatnagar P, Freund KB, Spaide RF, Klancnik JM, Cooney MJ, Ho I, Fine HF, Yannuzzi LA. INTRAVITREAL BEVACIZUMAB FOR THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION IN PSEUDOXANTHOMA ELASTICUM. Retina 2007; 27:897-902. [PMID: 17891014 DOI: 10.1097/iae.0b013e31809ff5df] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine the results of intravitreal bevacizumab injections for the management of choroidal neovascularization (CNV) in patients with pseudoxanthoma elasticum (PXE)-associated angioid streaks. METHODS A consecutive series of patients with PXE and CNV were managed with intravitreal bevacizumab injection (1.25 mg per 0.05 cc). The main outcome measures were visual acuity and greatest lesion height as measured by optical coherence tomography (OCT). RESULTS Nine eyes of nine consecutive patients received intravitreal bevacizumab (1.25 mg/0.05 mL) injections. The mean follow-up time was 6 months, during which eyes received an average of 1.8 injections. The baseline visual acuity was a mean of 20/368 and improved to 20/289 at the last visit (P = 0.056). Visual acuity either improved or stabilized in all 9 eyes (100%). Serial OCT measurements in 8 eyes showed a mean of 353 microm at baseline, which decreased to 201 mum at the last visit (P = 0.012). No complications were noted. CONCLUSIONS These short-term results support the use of intravitreal bevacizumab for the management of CNV in patients with PXE. Continued experience with intravitreal bevacizumab in this population will help establish its longer-term efficacy and better define the potential need for serial injections to maintain these results.
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Affiliation(s)
- Pawan Bhatnagar
- LuEsther T. Mertz Retina Research Center of the Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA
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Browning AC, Amoaku WM, Chung AK, Ghanchi F, Harding SP, Musadiq M, Yang YC, Talks SJ. Photodynamic Therapy for Angioid Streaks. Ophthalmology 2007; 114:1592. [PMID: 17678709 DOI: 10.1016/j.ophtha.2007.03.057] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Accepted: 03/22/2007] [Indexed: 11/30/2022] Open
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Lommatzsch A, Spital G, Trieschmann M, Pauleikhoff D. Intraokulare Injektion von Bevacizumab – Eine mögliche Therapie der sekundären CNV bei „angioid streaks“. Ophthalmologe 2007; 104:325-8. [PMID: 17334745 DOI: 10.1007/s00347-006-1456-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Angioid streaks are the typical ophthalmological manifestation of the systemic disease pseudoxanthoma elasiticum. Fundoscopy reveals angioid streaks as irregular dark brownish lines radiating from the area around the optic disc. Choroidal neovascularization (CNV) is the major cause of severe visual loss in patients with angioid streaks. Argon-laser treatment of CNV secondary to angioid streaks shows poor results. Photodynamic therapy (PDT) with verteporfin does not seem to be an effective treatment for achieving stabilization of visual acuity and lesion size in CNV secondary to angioid streaks. Results after a combination of the intravitreal application of triamcinolone with PDT did not show the expected benefit. In the era of promising new intravitreal treatments for patients suffering from age-related macular degeneration, it is interesting to observe this effect of angiogenesis inhibitors (bevacizumab, ranibizumab, pegaptanib) in patients with neovascilarization secondary to angioid streaks. In our case, we observed a deterioration in visual acuity and leakage of the CNV after treatment with PDT alone. However, after the intravitreal injection of bevacizumab, we observed an improvement in vision, and the area of neovascularization changed into a fibrotic scar. A controlled study with long-term results is needed to definitively evaluate this kind of treatment.
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Affiliation(s)
- A Lommatzsch
- Augenabteilung am St. Franziskus Hospital, Münster, Deutschland.
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Ruiz-Moreno JM, Montero JA. Photodynamic therapy in macular diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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