Surgical Lysis of Retinal Angiomatous Proliferation Using 25–Gauge Instrumentation

Abstract

Abstract: : Purpose: To evaluate the surgical removal of retinal angiomatous proliferation (RAP) using 25–gauge instrumentation in three patients. Methods: Ophthalmoscopy and fluorescein angiography were performed before and after 25–gauge vitrectomy using the Millennium^TM 25–gauge Transconjunctival Standard Vitrectomy (TSV) system with stripping of the posterior hyaloid to the equator, and diathermization of the proliferating retinal vessels. Next, under high perfusion pressure to maintain hemostasis, feeder arteriole surgical lysis was performed using 25–gauge vertical scissors. Air –fluid exchange was then performed after careful peripheral examination for retinal tears. Results: Three elderly patients with a long–standing history of neovascular age–related macular degeneration (AMD) presented acutely with metamorphopsia, decreased visual acuity of 20/200, 20/200, and 20/70, respectively, and intraretinal and subretinal hemorrhage and edema. Fluorescein angiography revealed stage 2 RAP with adjacent occult choroidal neovascularization secondary to AMD. Following uncomplicated surgical lysis of the feeder arteriole with 25–gauge vertical scissors, visual acuity improved to 20/50 in all three patients with significant reduction of intraretinal and subretinal fluid. No reperfusion of the lysed vessel was observed. Minimum follow–up was 6 months. No cataract progression was noted and intraocular pressure remained stable throughout the postoperative course. Conclusions: Surgical lysis of RAP using 25–gauge instrumentation may be safe and can result in visual stabilization or improvement.

Keywords: age-related macular degeneration • retina • vitreoretinal surgery