Pseudoxanthoma Elasticum

A patient with no past ocular history presented to the emergency department complaining of decreased vision in both eyes for 3-4 days. Exam was notable for a visual acuity of 20/25 in the right eye and 20/20 in the left eye. Intraocular pressures were 12 and 12. External exam revealed patches of inelastic skin on the neck. Anterior segment exam was unremarkable in both eyes. Posterior segment exam revealed angioid streaks, peripapillary atrophy, comet lesions, and a peau d’orange appearance to the fundus. Optical coherence tomography demonstrated an irregular contour of the RPE-Bruch’s membrane complex but no evidence of choroidal neovascularization. The patient was eventually lost to follow up but returned to the emergency department about 4 years later complaining of floaters and decreased vision in the left eye. A choroidal neovascular membrane was noted on exam and imaging. The patient was subsequently started on pro re nata treatment of intravitreal bevacizumab with anatomic and functional improvement.

Presentation Date: 02/17/2022

Issue Date: 03/04/2022