Retinal Angiomatous Proliferation: Natural History.

Abstract

Abstract: : Purpose: To describe the natural history of retinal angiomatous proliferation (RAP). Methods: Fourteen eyes of 12 consecutive patients with diagnosis of a RAP, at least in one eye, were prospectively followed from February 1994 without any treatment after a first visit to the clinic. Best corrected visual acuity, clinical biomicroscopic examination, dynamic fluorescein (d–FA) and indocyanine green angiography (d–ICGA), using a confocal scanning laser ophthalmoscope (Heidelberg Retinal Angiograph, Heidelberg Engineering GmbH, Dossenheim, Germany) were performed every three months in each patients. Results: Patients were followed for mean of 18 months (range, 3–44 months). The patients were all white (not of Hispanic origin) with an average age of 75. Nine (75%) were women and three (25%) were men. The affected eyes were unilateral in ten patients (83%) and bilateral in two patients (17%). Eight out of 10 unilateral patients had pre–existing nonspecific disciform disease with a retinal–choroidal anastomosis (RCA) in the fellow eye. At the first visit seven eyes with RAP were classified in stage 1 (50%) and seven eyes in stage 2 (50%). At the final examination three eyes persisted in stage 1 (21%), three eyes were diagnosed in Stage 2 (21%) and eight in stage 3 (58%). Four patients in stage 1 rapidly get worse in less than 10 months (3 patients progressing to stage 3 and 1 to stage 2) with an important decrease of the mean visual outcome (0.43 to 0.1). Four of five patients in stage 2 progressed to stage 3 in less than 4 months, complaining an important decrease in the mean visual acuity (0.35 to 0.1). Three patients in stage 1 and two in stage 2 had quite stable clinical course and visual outcome, but the follow–up for two patients was only 3 months. Conclusions: RAP lesion seems more common in female and are presdent in both eyes in most patients. The progression to poor vision is rapid. These findings are important with respect to natural history, and possibly to the treatment response and visual prognosis of patients with this type of neovascularized AMD.

Keywords: age–related macular degeneration • clinical (human) or epidemiologic studies: natural history • choroid: neovascularization