Retinal Angiomatous Proliferation: Association with Clinical and Angiographic Features

Abstract

Aim: It was the aim of this study to evaluate the frequency of retinal angiomatous proliferation (RAP) and its association with specific clinical and angiographic characteristics in age-related macular degeneration (AMD). Methods: A consecutive series of 126 newly diagnosed patients with exudative AMD was reviewed retrospectively. All underwent a complete ophthalmic examination, a red-free photograph and fluorescein angiography. Most patients (85/126) underwent indocyanine green choroidal angiography (ICGA). RAP was diagnosed when a connection between the retinal vasculature and the neovascular complex was recognized angiographically. Results: Out of 126 patients with recent neovascular AMD, 17 had RAP (13.5%; 95% CI 8.1–20.7). The study eye of patients with RAP had more frequent hemorrhages (88.2 vs. 59.6%; p = 0.027), hard exudates (82.4 vs. 26.6%; p < 0.001), pigment epithelium detachment (64.7 vs. 23.8%; p = 0.001) and a hot spot in ICGA (70.6 vs. 22.1%; p < 0.001) with respect to the other forms of exudative AMD. Hemorrhages were more frequently superficial, multiple and within the edge of the lesion in the RAP group. Bilateral AMD was more common in the RAP group (70.6 vs. 38.0%; p = 0.011). No statistically significant differences were found regarding sex, age and visual acuity. Conclusion: RAP represents a common lesion in patients with neovascular AMD referred to a tertiary care clinic. The recognition of hemorrhages, hard exudates, pigment epithelium detachment or a hot spot in ICGA can assist a correct diagnosis.

Ranibizumab for retinal angiomatous proliferation in neovascular age-related macular degeneration

“…Retinal angiomatous proliferation (RAP) is a distinctive form of neovascular age-related macular degeneration (AMD) in which new vessels originate from the middle and inner retina instead of arising from the choroidal circulation as in choroidal neovascularization [4,10]. These neovascularizations may eventually grow into the choroidal layer, forming retinal-choroidal anastomosis [10].…”

Multimodal Evaluation of the Fellow Eye of Patients with Retinal Angiomatous Proliferation

“…Although the fellow eyes of RAP have already been multimodally studied [9,14,15,21], no reports on OCTA analysis are yet available in the literature. OCTA enables the 3-dimensional assessment of vascular flow within the retina and choroid, thereby providing new data on the pathogenesis of RAP and enhancing the accuracy of its diagnosis [22].…”

“…Yannuzzi et al [6] suggested that the initial vasogenic event in RAP is the abnormal proliferation of intraretinal capillaries. These new vessels originate from the middle and inner retina, organize into retinalretinal anastomosis and then spread into the choroid (retinal-choroid anastomosis), as initially described by Hartnett et al [8] in 1992, and later classified by Yannuzzi et al [6] in a 3-stage development process [9,10]. In 2008, however, Yannuzzi et al [11] described 5 cases of RAP in which the neovascular complex first originated in the choroid instead of the retina.…”

“…Some funduscopic features have been described as typical signs of RAP, such as intraretinal hemorrhages [12], tortuous retinal vessels, the sudden disappearance of a retinal vessel that appears to have moved deeper, hard exudates around the retinal lesion, soft drusen, subretinal drusenoid deposits, pigmentary changes, and pigment epithelium detachment (PED), which may reflect the presence of intraretinal angiomatosis and/or newly formed subepithelial vessels [9,12,13]. Fellow eyes of RAP have also been thoroughly assessed [9,14,15], but a meticulous and comprehensive multimodal analysis integrating optical coherence tomography angiography (OCTA) findings is still missing.…”

“…Fellow eyes of RAP have also been thoroughly assessed [9,14,15], but a meticulous and comprehensive multimodal analysis integrating optical coherence tomography angiography (OCTA) findings is still missing.…”