A CASE OF RETINAL ANGIOMATOUS PROLIFERATION IN AGE-RELATED MACULAR DEGENERATION

Title A CASE OF RETINAL ANGIOMATOUS PROLIFERATION IN AGE-RELATED MACULAR DEGENERATION
Author, Co-Author Yu Su, Christopher Rinehart, Andrew Gurwood
Topic
Year
2009
Day
Friday
Program Number
95970
Room
Crystal H
Affiliation
Pennsylvania College of Optometry at Salus University
Abstract BACKGROUND: Retinal angiomatous proliferation (RAP) is a distinct form of neovascular age-related macular degeneration (AMD), characterized by the initial presentation of dilated retinal vessels, pre-, intra- and sub-retinal hemorrhages along with exudation. Many believe the angiomatous process is an atypical variation of retinal neovascularization (NV), as progression finds the lesion moving deep into retina and choroid, forming retinal-choroidal anastomosis (RCA). This is different from the NV seen in typical wet AMD as traditional choroidal neovascularization (CNV) proliferates from choroid to the overlying retina.

CASE REPORT(S): An 81 year old Caucasian male presented with a chief complaint of decreased vision with metamorphosia of 4 months duration, OU. His best corrected visual acuity measured 20/100 OD and 20/50 OS. Fundus examination found multiple large soft drusen in the posterior pole with central intra-retinal hemorrhages OD and multiple intermediate soft drusen OS. The patient was referred to retinology where indocyanine green angiography (ICG) demonstrated a "hot spot" uncovering a diagnosis of RAP. Anti-VEGF therapy was initiated.

CONCLUSIONS: Retinal angiomatous proliferation appears to be a subgroup of neovascular AMD with its own characteristics and clinical and angiographic manifestations. The lesion contains proliferation from both retinal and choroidal circulations which distinguishes it from the classic CNV derived from advanced wet AMD. Photodynamic therapy should be used with caution in these cases as it predisposes the retina to photochemical damage.
Affiliation of Co-Authors Pennsylvania College of Optometry at Salus University, Pennsylvania College of Optometry at Salus University
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