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F. Bottoni, A. Massacesi, M. Cigada, F. Viola, G. Staurenghi; Treatment of Retinal Angiomatous Proliferations (RAP). An interventional case series. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3102.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the management of RAP, a recently described intraretinal neovascular lesion that occurs in age–related macular degeneration (AMRD). Methods: We retrospectively reviewed the charts of 73 consecutive patients with ARMD who were affected by 100 RAPs evaluated at the two study centers. Diagnosis of RAP was based on dynamic ICG angiography (SLO,HRA–Heidelberg Engineering, Germany) and each lesion was cathegorized into three different stages as recently suggested (Yannuzzi LA et al, Retina, 2001; 21:416). Four treatment modalities were performed: direct laser photocoagulation of the vascular lesion, laser photocoagulation of the feeder retinal arteriole, scatter "grid–like" laser photocoagulation and photodynamic therapy (PDT). The clinical data were statistically analyzed (ANOVA) to obtain two main outcome measures: complete obliteration of the lesion and final visual acuity (VA). Results: Overall, 41 RAPs were at stage I, 39 at stage II and 20 at stage III. Stage I: A complete obliteration was achieved in 16 out of 21 lesions (76%) submitted to direct laser photocoagulation (final VA: ≥ 0.3, 15 eyes; ≤ 0.1, 5 eyes), compared to 7 out of 11 lesions (64%) managed with PDT (final VA: ≥ 0.3, 6 eyes; ≤ 0.1, 4 eyes) and 3 out of 6 lesions (50%) treated with scatter "grid–like" laser photocoagulation (final VA: ≥ 0.3, none; ≤ 0.1, 3 eyes). Stage II: : A complete obliteration was achieved in 2 out of 11 lesions (18%) submitted to direct laser photocoagulation (final VA: ≥ 0.3, 5 eyes; ≤ 0.1, 6 eyes), compared to 2 out of 7 lesions (29%) managed with PDT (final VA: ≥ 0.3, none; ≤ 0.1, 4 eyes) and 5 out of 13 lesions (38%) treated with scatter "grid–like" laser photocoagulation (final VA: ≥ 0.3, 1 eye; ≤ 0.1, 10 eyes). Stage III: no treatment benefit was recorded with a final VA ≤ 0.1 in every eye. Initial VA (P=0,01) and stage of the lesion (P=0,003) were predictors of final VA with good presenting VA and earlier stages (I) being associated with better functional outcomes. Conclusion: Early detection of the lesion and subsequent direct conventional laser photocoagulation seems to be associated with better anatomical and functional outcomes. Once the vascular complex is well established, anatomical closure is rarely achieved with any treatment modality.
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