Angioid streaks-related choroidal neovascularization: Clinical features, multimodal imaging-based differential diagnosis, and optimized treatment strategies.

Abstract

Angioid streaks-related choroidal neovascularization (AS-CNV) is a vision-threatening complication arising from breaks in a calcified Bruch membrane, commonly associated with systemic conditions such as pseudoxanthoma elasticum (PXE). This review comprehensively addresses the clinical features of AS-CNV, emphasizing its distinct pathophysiology and systemic implications. We highlight the critical role of multimodal imaging-including color fundus photography, fundus autofluorescence, fluorescein and indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography-in accurately diagnosing and differentiating AS-CNV from other choroidal neovascular pathologies. The integration of imaging biomarkers and vascular pattern analysis facilitates early detection of subclinical and quiescent CNV, allowing for timely, individualized anti- vascular endothelial growth facgtor therapy. Additionally, the systemic management of PXE and its cardiovascular, renal, and gastrointestinal manifestations is underscored to optimize overall patient outcomes. We provide an up-to-date synthesis of diagnostic advances and treatment strategies aimed at improving visual prognosis in patients with AS-CNV.