The Fellow Eye in Retinal Angiomatous Proliferation (RAP)

Abstract

Abstract: : Purpose: To characterize the natural course of the uninvolved fellow eyes of patients with unilateral retinal angiomatous proliferation (RAP). Methods: Fellow eyes of 30 consecutive patients with unilateral RAP were prospectively followed after a first visit to the clinic. Clinical biomicroscopic examination, dynamic fluorescein (d–FA) and indocyanine green angiography (d–ICGA) and stereo angiographies, using a confocal scanning laser ophthalmoscope (SLO, HRA–Heidelberg Engineering, Germany) were used to evaluate patients. The primary eligibility criterion for the study was the presence in one eye of ARMD with diagnosis of RAP based on d–FA and d–ICGA and an uninvolved fellow eye. Exclusion criteria were as follows: evidence of current or past choroidal neovascularization, serous pigment epithelial detachment, high myopia, angioid streaks, infectious or inflammatory chorioretinal disease, trauma, previous laser treatment and other progressive ocular diseases in the fellow eye. Results: 30 patients were followed for mean of 24 months (range, 5–50 months). The patients were all white and had an average age of 79 (range, 61–92). 25 (83%) were women and 5 (17%) were men. In nine eyes (30%) a new RAP (7 in Stage I and 2 in Stage II) developed in the fellow eye over the follow–up and 1 eye developed a classic CNV. The average onset for neovascular involvement in the fellow eye was 23 months (range, 5–47). In 8 eyes (27%) geographic atrophy evolved gradually over time initially sparing the fovea. The eyes that developed an increase of atrophy experienced more visual acuity loss than did eyes with RAP, because of the characteristic extrafoveal localization of this neovascularization at early stage. Conclusions: Patients who develop RAP in one eye are at considerable risk of developing a new RAP or an increase of geographic atrophy in the fellow eye. These data would suggest that patients with RAP in one eye should be strictly monitored in the fellow eye so that a diagnosis at early stage of this form of neovascularization can be promptly identified.

Keywords: age-related macular degeneration • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • choroid: neovascularization