- Linear cracks in a thickened Bruch's membrane.
- Occurs bilaterally, but asymmetric
- Clinical features:
- Symptoms: usually asymptomatic, but may affect vision over
time due to progression of streaks towards the fovea
- Signs:
- Irregular, spokelike, curvilinear or jagged streaks that
radiate outward from the peripapillary area towards the peripheral
fundus or can be concentric to the optic disc
- Near the optic disc, they may be interconnected by circular
breaks
- Color varies from reddish orange to dark brown, or appear
grayish if fibrovascular tissue is present
- Associated funduscopic findings may include:
- Peau d'orange (orange skin) pattern of diffuse mottling
of the pigment epithelium in the temporal midperiphery
- Peripheral subretinal crystalline bodies
- Focal atrophic spots
- Optic nerve drusen
- Fluorescein angiographic findings:
- Irregular hyperfluorescence of the streaks during early phases
and late staining
- Can be seen as hypofluorescence of the streaks outlined by
hyperfluorescence margins, which stain in the late phases
- Some clinically invisible streaks may be observed during fluorescein
angiography
- Most common associated systemic conditions:
- Idiopathic
- Pseudoxanthoma elasticum (PXE)
- Paget's disease
- Sickle cell disease
- Ehler's- Danlos Syndrome
- Complications:
- Choroidal neovascularization
- High risk of severe subretinal hemorrhages due to rupture of
the Bruch's membrane following a relatively mild ocular injury
- Management: laser photocoagulation in selected cases of choroidal
neovascularization, but the recurrence rate is high.
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