Angioid streaks and disciform macular detachment in Paget's disease (Osteitis deformans)

A patient with angioid streaks and Paget's disease of bone was followed with serial fundus photographs and fluorescein angiography because of progressive loss of central vision secondary to serous and hemorrhagic disciform detachment of the macula. At autopsy, histopathologic examination of his eyes revealed linear breaks in an extensively calcified and degenerated Bruch's membrane. These breaks corresponded to the clinically observed angioid streaks. Fibrovascular in-growth from the choroid into the subpigment epithelial and subretinal space was the cause of the disciform macular detachment. Paget's disease, which is often clinically inapparent, should be suspected in all patients with angioid streaks.