This patient initially presented with dramatic pigmented angioid streaks and acute vision loss from macular neovascularization.
The classic peau d’orange (orange skin) pigmentary changes are seen in the temporal macula.
Seven years later, vision is 20/25 with ongoing anti-VEGF therapy. The angioid streaks are best imaged with the Optos green channel.
Learning Points:
Macular neovascularization is a complication of virtually any disorder that affects Bruch’s membrane, the most common being age-related macular degeneration, ocular histoplasmosis, idiopathic, degenerative myopia (lacquer cracks), trauma (choroidal rupture), and angioid streaks.
