Retinal Angiomatous Proliferation

Abstract

Abstract: : Purpose: To present the clinical features and response to treatment of patients presenting with Retinal Angiomatous Proliferation (RAP) during a 21 month period. Methods: Retrospective consecutive case series. Patients presenting with recent onset of symptoms between February 2003 and October 2004 and diagnosed with Retinal Angiomatous Proliferation (RAP) were included in this study. The diagnosis of RAP was made on criteria which included the presence of intraretinal haemorrhages corresponding to focal hyperfluorescence in the late frames of Indocyanine Green Angiography in patients with a diagnosis of ARMD. The primary outcome was loss of 2 or more lines of Snellen visual acuity, with RPE rip a secondary outcome. Results: Thirteen patients with a mean age of 78 years (range 69–95) were identified. Four had a pigment epithelial detachment (PED) on presentation. Eight patients had a disciform scar in the fellow eye and a chorioretinal anastomosis was seen in 6 of these. None of the fellow eyes had a rip of the retinal pigment epithelium. The mean length of follow up was 7 months (range 1–16). The mean visual acuity in the study eye at presentation was 20/50 and the mean final visual acuity was 20/150. Seven patients were treated with argon laser photocoagulation to the focal area of hyperfluorescence. Of these 7 treated cases, 5 had persistence of intraretinal haemorrhages and subretinal fluid, and 4 received repeat argon laser treatment. Three went on to be treated with photodynamic therapy. Fifty–seven percent (4/7) lost 2 or more lines of Snellen acuity. Three patients developed RPE rips post argon laser treatment, 2 of whom had received 2 sessions of photocoagulation. Two patients with an initial good visual acuity of 20/30 had preservation of vision following argon laser photocoagulation. Six patients did not receive treatment because of the presence of either a large PED, a large area of occult choroidal neovascularisation seen on fluorescein angiography, or patient preference. Thirty three percent (2/6) lost two or more lines of Snellen acuity. No RPE rips were observed in the untreated group. Conclusions: RAP is an uncommon subtype of macular degeneration. The most favourable outcomes post laser photocoagulation are seen in patients with initial good visual acuity, minimal hyperfluorescence on ICG angiography and no PED at presentation.

Keywords: age-related macular degeneration • choroid: neovascularization • retinal neovascularization