Abstract
Abstract: :
Purpose: To report: (1) the prevalence of retinal angiomatous proliferation (RAP) within a consecutive case series of patients with exudative macular degeneration; (2) the clinical, fluorescein angiography, and optical coherence tomogragphy (OCT) findings of RAP. Methods: We performed a retrospective observational review of all cases diagnosed as age–related macular degeneration over a 9–month period (February 2003 through October 2003). All patients included in the study had color fundus photos, fluorescein angiography, and OCT at the first presentation of exudative changes. Patients with non–exudative ARMD, disciform scars, or previously treated exudative lesions were excluded. Results: We identified 65 consecutive patients (80 eyes) with exudative age–related macular degeneration. The prevalence of RAP was 20% (13/65 patients, 16/80 eyes). There was a female preponderance of 77% (10/13, p = 0.05) with RAP; mean age was 79 (median 85, SD 9.6; p = 0.10 for age over 80). Hypertension, diabetes, and cardiac disease were not found to be more prevalent with RAP (p = 0.89, p = 0.20, p = 0.66, respectively). Clinical findings of RAP included intra–retinal hemorrhages in 87.5 % (14/16, p < 0.001) and intra–retinal exudates 31% (5/16, p < 0.001). Fluorescein angiography findings included a focal, limited hyperfluorescent lesion (hot–spot) in 62.5% (10/16, p < 0.001) and a serous PED in 56% (9/16, p < 0.001). OCT findings included a large serous PED in 75% (12/16 eyes, p = 0.003), intra–retinal cystic edema in 75% (12/16, p = 0.01), and intra–retinal focal hyperreflectivity in 69% (11/16, p < 0.001). Conclusions: Retinal angiomatous proliferation represents a significant percentage of exudative ARMD. The clinical signs include intra–retinal hemorrhages, intra–retinal exudates, and PED. We found OCT to be of paramount importance in the diagnosis of RAP, characteristic findings will be discussed. Fluorescein angiograms may not be sufficient alone to make the diagnosis of RAP. Although in this study ICG was not used, it may have added value in diagnosing indeterminate cases.
Keywords: age–related macular degeneration • clinical (human) or epidemiologic studies: prevalence/incidence