Six Month Follow-Up of Surgical Ablation for Stage 2 Retinal Angiomatous Proliferation

Abstract

Abstract: : Purpose: Retinal angiomatous proliferation (RAP) is a recently described type of exudative age-related macular degeneration (AMD) that is difficult to treat with laser photocoagulation. Recently, we developed a novel surgical approach for the treatment of stage 2 RAP. We describe the long-term follow up of patients treated with this technique. Methods: 10 eyes underwent pre- and post-operative assessment with visual acuity measurements, fluorescein angiography (FA) and high-speed ICG angiography (HSICG), and optical coherence tomography (OCT). After a pars plana vitrectomy with confirmation of a posterior vitreous detachment, sequential surgical lysis of the feeding arteriole and draining venule was performed with the assistance of vascular maps obtained pre-operatively. The lysed ends were diathermized. The patients were followed for a minimum of six months post-operatively. Results: Average pre-operative visual acuity was 20/200. At a minimum of 6 month follow up, the mean visual acuity was 20/80. There were 4 recurrences which were successfully treated with additional surgery. Resolution of intraretinal edema and associated pigment epithelial detachment was confirmed by OCT and FA. Post operative HSICG showed closure of the lesion in all patients. There were no cases of retinal detachment or endophthalmitis in this series. Conclusions: Surgical lysis of feeder vessels in Stage 2 RAP is an effective means of controlling intraretinal edema and improves vision in this group of patients with exudative AMD at a minimum of 6 months after surgery. Further study of this novel treatment is indicated.

Keywords: age-related macular degeneration • choroid: neovascularization