Retinal Angiomatous Proliferations: When Should We Suspect Them and How Should We Detect Them?

 

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Zusammenfassung

Hintergrund: Erkennung klinischer und angiografischer Charakteristika retinaler angiomatöser Proliferation (RAP) bei Patienten mit altersbedingter Makuladegeneration. Patienten und Methoden: 26 Augen von 24 Patienten mit RAP wurden einer retrospektiven Analyse unterzogen bei Vorlage von Farb- und s/w-Bild, Fluoreszein- (FA-) und Indozyaningrün-Angiografie (ICGA). Biomikroskopie und Angiografien wurden ausgewertet und die Videosequenzen zur RAP-Einteilung verwendet. Ergebnisse: Es wurden 29 RAP diagnostiziert. Stadium 1 war bei 3 / 29, Stadium 2 bei 3 / 29 vorhanden, Stadium 3 bei 23 / 29, von denen 21 chorioretinale Anastomosen hatten. Insgesamt waren 83 Gefäße beteiligt, 35 davon waren Arterien, 48 Venen. RAP erschienen zumeist als „hot Spots“, in nur einem Fall plakoid. Retinale Pigmentepithelabhebung (PED) wurde in 22 / 26 Fällen per ICGA gesehen, zystoides Makulaödem bei 13 / 26 per FA und intraretinale ICG-Leckage bei 6 / 26 Augen. Retinale Blutungen traten bei 23 / 26 Augen auf; nur eine davon war nicht intraretinal und kleiner als einen halben Papillendurchmesser groß. 2 / 24 Patienten wiesen bilaterale RAP auf. Schlussfolgerungen: Der Verdacht auf RAP besteht bei harten Exsudaten, feinen intraretinalen Blutungen, Pigmentepithelabhebung und „hot Spot“ in der ICGA. Sowohl FA- als auch ICG-Videoangiografie bieten eine ausreichende zeitliche Auflösung und retinale Flussdarstellung, die eine RAP-Stadieneinteilung und Darstellung von Anastomosen ermöglicht.

Abstract

Background: The aim of this study was to identify the clinical and angiographic features of retinal angiomatous proliferations (RAPs) in patients with age-related macular degeneration. Patients and Methods: 26 eyes of 24 patients with RAPs were retrospectively reviewed. All patients had colour and red-free photographs, and fluorescein (FA) and indocyanine-green angiography (ICGA). The biomicroscopic and angiographic characteristics were evaluated and video-angiograms were analysed for staging the RAPs. Results: The total number of RAPs was 29. Stage 1 was present in 3 / 29, stage 2 in 3 / 29 and stage 3 in 23 / 29 with a chorio-retinal anastomosis identified in 21 of these 23 eyes. The total number of retinal vessels involved were 83, 35 were arteries and 48 were veins. RAPs were seen in ICGA as hot spots in all but one case where it appeared as a plaque. A retinal pigment epithelial detachment (PED) was observed in 22 / 26 eyes. Cystoid macular oedema was observed in 13 / 26 eyes in FA and intraretinal ICG leakage in 6 / 26 eyes. Hard exudates were present in 21 / 26 eyes. Retinal haemorrhages were present in 23 / 26 eyes; all but one were intraretinal and had a size of less than half of the optic disc diameter. The RAP was bilateral in 2 / 24 patients. Conclusions: Clinicians should suspect the diagnosis of RAP when hard exudates, small intraretinal haemorrhages, PED or a hot spot in ICGA are present. Both fluorescein and ICG video-angiography provide adequate temporal resolution and vascular flow examination leading to easier RAP staging and identification of the anastomosis.

References

• 1 Bearelly S, Espinosa-Heidmann D G, Cousins S W. The role of dynamic indocyanine green angiography in the diagnosis and treatment of retinal angiomatous proliferation.  Br J Ophthalmol. 2008;  92 191-196
  Google Scholar
• 2 Borrillo J L, Sivalingam A, Martidis A. et al . Surgical ablation of retinal angiomatous proliferation.  Arch Ophthalmol. 2003;  121 558-561
  Google Scholar
• 3 Bottoni F, Massacesi A, Cigada M. et al . Treatment of retinal angiomatous proliferation in age-related macular degeneration: a series of 104 cases of retinal angiomatous proliferation.  Arch Ophthalmol. 2005;  123 1644-1650
  Google Scholar
• 4 Freund K B, Klais C M, Eandi C M. et al . Sequenced combined intravitreal triamcinolone and indocyanine green angiography-guided photodynamic therapy for retinal angiomatous proliferation.  Arch Ophthalmol. 2006;  124 487-492
  Google Scholar
• 5 Gross N E, Aizman A, Brucker A. et al . Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation.  Retina. 2005;  25 713-718
  Google Scholar
• 6 Johnson T M, Glaser B M. Focal laser ablation of retinal angiomatous proliferation.  Retina. 2006;  26 765-772
  Google Scholar
• 7 Krebs I, Stolba U, Glittenberg C. et al . Prognosis of untreated occult choroidal neovascularization.  Graefes Arch Clin Exp Ophthalmol. 2007;  245 376-384
  Google Scholar
• 8 Krieglstein T R, Kampik A, Ulbig M. Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation.  Br J Ophthalmol. 2006;  90 1357-1360
  Google Scholar
• 9 Slakter J S, Yannuzzi L A, Schneider U. et al . Retinal choroidal anastomoses and occult choroidal neovascularization in age-related macular degeneration.  Ophthalmology. 2000;  107 742-753; discussion 753 – 744
  Google Scholar
• 10 Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group . Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials-TAP report.  Arch Ophthalmol. 1999;  117 1329-1345
  Google Scholar
• 11 Wolf A, Kook D, Kreutzer T. et al . Intravitreale Anti-VEGF-Behandlung retinaler angiomatöser Proliferationen.  Ophthalmologe. 2008;  105 845-851
  Google Scholar
• 12 Yannuzzi L A, Negrao S, Iida T. et al . Retinal angiomatous proliferation in age-related macular degeneration.  Retina. 2001;  21 416-434
  Google Scholar

Prof. Constantin J. Pournaras, MD

Department of Ophthalmology, Geneva University Hospitals

22 rue Alcide Jentzer

1211 Geneva 14

Switzerland

Phone: ++ 41/22/3 82 83 94

Fax: ++ 41/22/3 82 84 21

Email: constantin.pournaras@hcuge.ch