Abstract
PurposeThe present study aimed to evaluate the characteristics of fundus autofluorescence in Japanese patients with retinal angiomatous proliferation (RAP).MethodsWe retrospectively reviewed 100 eyes from 76 patients (male, n = 45; female, n = 31; age range, 50–94 years; mean ± standard deviation, 81.4 ± 6.4 years) with treatment-naïve RAP, which was diagnosed based on the identification of retinal–retinal anastomosis on early-phase fluorescein angiography or indocyanine green angiography (ICGA) and the identification of a hot spot on late-phase ICGA. RAP was classified into the following three stages: stage 1, proliferation of intraretinal capillaries originating from the deep retinal complex (intraretinal neovascularization); stage 2, growth of the retinal vessels into the subretinal space (subretinal neovascularization); and stage 3, clinically or angiographically observed choroidal neovascularization. In all cases, short-wavelength and near-infrared autofluorescence (SW-AF, NIR-AF) was evaluated using a confocal scanning laser ophthalmoscope.ResultsThe conditions of the 100 eyes were as follows: stage 1 RAP, n = 6 (6%); stage 2 RAP without retinal pigment epithelial detachment (PED), n = 40 (40%); stage 2 RAP with PED, n = 44 (44%); and stage 3 RAP, 10 (10%). On NIR-AF imaging, the number of abnormalities that were observed to correspond to the RAP lesions on ICGA (87 eyes, 87%) was significantly greater in comparison to SW-AF imaging (27 eyes, 27%). The mean follow-up period in all 76 patients was 39.2 months. In the 76 patients with unilateral disease, 21 (21%) eyes developed RAP in the fellow eye during the follow-up period. Among 18 eyes that were examined by both SW-AF and NIR-AF imaging before the onset of RAP lesions, NIR-AF imaging showed hypoautofluorescence in 15 (83%) eyes before the onset of RAP lesions.ConclusionsSW-AF and NIR-AF abnormalities may be related to the dysfunction of the photoreceptor/retinal pigment epithelium complex. Hypoautofluorescence on NIR-AF imaging may accurately indicate the presence or onset of RAP lesions.
Highlights
Yannuzzi et al [1], who first identified retinal angiomatous proliferation (RAP) in 2001, described the disease as a variant of exudative age-related macular degeneration (AMD)
On near-infrared fundus autofluorescence (NIR-AF) imaging, the number of abnormalities that were observed to correspond to the RAP lesions on indocyanine green angiography (ICGA) (87 eyes, 87%) was significantly greater in comparison to Short-wavelength autofluorescence (SW-AF) imaging (27 eyes, 27%)
SW-AF and NIR-AF abnormalities may be related to the dysfunction of the photoreceptor/ retinal pigment epithelium complex
Summary
Yannuzzi et al [1], who first identified retinal angiomatous proliferation (RAP) in 2001, described the disease as a variant of exudative age-related macular degeneration (AMD). Anti-vascular endothelial growth factor (VEGF) monotherapy using intravitreal ranibizumab or aflibercept for RAP requires repeated treatments. We hypothesized that the combination therapy of intravitreal anti-VEGF agents and photodynamic therapy may allow the visual acuity (VA) and retinal morphology of patients with RAP to be improved or maintained with fewer treatments [10,11,12,13,14]. Retinal pigment epithelium (RPE) atrophy, which can result in reduced VA, has been reported to develop after treatment in patients with RAP [15,16,17,18,19]. New examinations are needed to diagnose RAP before the onset of RAP lesions, and may be important for the management of patients with RAP
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