Retinal angiomatous proliferation: clinical characteristics and treatment options.
BACKGROUND
A new form of exudative age-related macular degeneration (ARMD), retinal angiomatous proliferation (RAP), has been described in which neovascularization begins in the deep retina, extends through the subretinal space, and eventually communicates with choroidal neovascularization.


METHODS
Case series.


RESULTS
Common clinical features of RAP include small multiple intra-retinal hemorrhages, intra-retinal edema, vascularized pigment epithelial detachments (PEDs), and retinal choroidal anastomosis (RCA). Fluorescein angiography (FA) reveals ill-defined, occult choroidal neovascularization. Indocyanine green (ICG) angiography is useful in early stages because 'hot spots' can be detected before clinical or FA characteristics are present. Optical coherence tomography (OCT) is useful in illustrating some of the clinical and FA characteristics. The use of photodynamic therapy (POT), combined with intravitreal triamcinolone injection, was successful in stabilizing the RAP lesion in one case discussed in this report.


CONCLUSIONS
Retinal angiomatous proliferation is a newly recognized entity of exudative age-related macular degeneration with its own set of clinical, FA, ICG angiography, and OCT features. Experimental treatments such as the use of PDT combined with intravitreal triamcinolone injection demonstrate potential success with this entity. The biggest hope appears to be anti-angiogenic factors currently in clinical trials for the treatment of exudative ARMD.
Miami VA Medical Center, Miami, Florida 33125, USA. megan.hunter@med.va.gov
Megan A
MA
Hunter
Mark T
MT
Dunbar
Phillip J
PJ
Rosenfeld
D000368:Aged; D000369:Aged, 80 and over; D000798:Angiomatosis / Q000175:diagnosis* / Q000188:drug therapy*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy; D010778:Photochemotherapy; D015861:Retinal Neovascularization / Q000175:diagnosis* / Q000188:drug therapy*; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
D014222:Triamcinolone Acetonide; D007208:Indocyanine Green