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R.P. Murphy, M. Albano, W.L. Gilmer, The Retina Group of Washington Study Group; Treatment of Retinal Angiomatous Proliferation Lesions Associated With Pigment Epithelial Detachment With Focal Pulsed Laser . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2145.
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To evaluate focal pulsed laser treatment as the primary therapy for inner retinal angiomatous proliferation (RAP) lesions associated with retinal pigment epithelial detachment (PED) defined by video indocyanine green angiography (ICG–A) and fluorescein angiography (FA).
Retrospective chart review of consecutive patients with at least six months of follow–up who had PED associated with RAP. Eyes with any choroidal neovascularization (CNV) were excluded. After ICG–A identification and lesion localization, treatment was completed with confluent pulsed 532 nm laser applications (spot sizes 75 – 200 microns.) Treatment endpoint was mild inner retinal greying over the RAP.
Forty six eyes (41 patients) were studied. 85.4% were women. All five bilateral eyes were in women. Mean age was 80.4 years. (Range = 63 to 91 years.) Mean baseline visual acuity was 44.3 ETDRS letters (Snellen equivalent = 20/130). On FA 67.4% had a pattern of PED only; 26.1% had PED with an occult leakage pattern and 6.5% had PED with other patterns that mimicked CNV. On ICG–A, the inner retinal lesions were well–defined and small (100 – 400 microns). After treatment, there was a mean decrease compared to baseline of –0.8 EDTRS letters at 3 months, –4.4 at 6 months and –8.7 at 12 months (80.4% follow–up). Most had multiple treatments. At six months the proportion of eyes with stable or improved vision was 79.6%; at 12 months 67.7%. At 6 months 29/46 (63.0%) of RAP were closed; at 12 months 29/37 (78.4%) were closed. At 6 months 20/46 (43.5%) of PED's had resolved; 27/37 (73.0%) resolved by 12 months. Another 6/37 (16.2%) progressed to fibrovascular scars with no PED.
In this series RAP could not be diagnosed by FA alone, but required ICG–A for confirmation. For RAP associated with PED, early ICG–A identification and initial focal pulsed laser treatment was a safe, effective treatment strategy for this type of retinal neovascularization. There was little initial adverse treatment effect, with sustained visual benefit for one year. Closing the RAP lesion can be associated with resolution of the PED, suggesting that leakage from RAP may induce them. Treatment failure could be associated with progression to CNV. Further follow–up to determine long–term visual outcome is warranted. Supplemental therapy, when indicated, with either photodynamic therapy or anti–VEGF agents is now considered for early treatment failures or progression to CNV.
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