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M.F. Elashry, I. Ashfaq, S. Pagliarini; Unusual Vascular Abnormalities in Retinal Angiomatous Proliferations (RAP) . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2159.
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To report unusual phenotypes of retinal vascular abnormalities associated with RAP.
In a retrospective review of RAP (17 patients, 19 eyes) five eyes of five patients were identified to have peculiar retinal vascular abnormalities on fluorescein and indocyanine green angiography obtained by confocal scanning laser ophthalmoscopy (HRA2 Heidelbergh Engineering).
All five patients were Caucasian with a mean age of 81 years, 4 of whom were females. They all had stage 1 RAP at presentation with single or multiple intraretinal hot spots (focal areas of intense hyperfluorescence). Three patients received laser treatment to the hot spot (one to 2 hot spots) combined to 4 mg intravitreal triamcinolone acetonide injection resulting in temporary resolution of leakage. All eyes at presentation or during follow up (2–13 months) showed peculiar vascular patterns at the location of or contiguous to the hot spots consisting of retinal vessels with irregular course, looping back on themselves, or dipping down, or crossing the raphe to anastomose with vessels originating from the opposite arcade. Blunt termination, vessel duplication, comma shaped appearance and interrupted saccular dilatations were also seen. In the treated eyes these change occurred away from the lasered hot spot, at multiple locations. This microangiopathy preceded the development of deep subretinal neovascular complexes that were anastomosed to the superficial retinal capillary network.
A broad spectrum of retinal vascular abnormalities may be observed in RAP prior to the development of a subretinal neovascular complex. These findings enhance our understanding of the clinical spectrum of RAP and may be helpful to interpret its controversial pathogenesis.
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