Deep Retinal Vascular Anomalous Complexes in Advanced Age-related Macular Degeneration

Cone photopigment in older subjects: decreased optical density in early age-related macular degeneration

“…Central vision, dominated by cone photoreceptors, is lost to varying extents in different patients, over a number of years, and in a variety of patterns.2 -9 The visual prognosis for an individual patient is often unpredictable, with vision loss due not only to atrophy8 but also to the onset and severity of exudative changes such as choroidal new vessels and retinal pigment epithelial detachments. 10,11 Functional damage to cone photoreceptors has been shown to occur early in AMD, before atrophy or exudation, 3,4,7,[12][13][14] as well as damage to a variety of other aspects of cone pathway function. 5,[15][16][17][18][19][20] Several types of damage have been hypothesized to occur early in the disease.…”

Pigment Epithelial Detachments with Retinal Vascular Anomalous Complex in Age-Related Macular Degeneration

“…Occult, classic and mixed CNV seem to be the most common forms of neovascular AMD [8, 9]. Recently, RVAC has been recognized and reported [4, 6, 10] in primary occult classified CNV. Compared with the other forms of CNV in AMD, RVAC differs in that it originates from the retinal circulation.…”

“…Recently, some studies have observed that the reverse may occur in a subgroup of patients with newly diagnosed AMD. This form of neovascularization has been termed retinal vascular anomalous complex (RVAC) [4], retinal choroidal anastomosis [5] or retinal angiomatous proliferation [6]. RVAC may start with the proliferation of retinal capillaries and form intraretinal and subretinal neovascularization, which is often asymptomatic.…”

Angiographic and OCT features of retinal angiomatous proliferation

“…They described nine patients with pigment epithelium detachment (PED) and associated retinal vascular abnormalities, described as 'retinal angiomatous lesions'. Later, Kuhn et al 2 identified an RCA as a potential manifestation of this subtype of AMD and Hartnett et al 3 suggested that the neovascularization was deep in the retina and an anastomosis connecting the retina circulation to a deep retinal vascular lesion, namely 'deep retinal vascular anomalous complex', was characteristic of the disorder. In 2000, Slakter et al 4 recognized an RCA with or without a PED as a form of AMD resistant then to the standard wet AMD care (laser photocoagulation).…”