Treatments of Stage 1 Retinal Angiomatous Proliferation

Phil Young Lee; Won Ki Lee

doi:10.3341/jkos.2008.49.3.442

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Lee and Lee: Treatments of Stage 1 Retinal Angiomatous Proliferation

Original Article

J Korean Ophthalmol Soc 2008;49(3):442-449.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.3.442

Treatments of Stage 1 Retinal Angiomatous Proliferation

Phil Young Lee, M.D.¹, Won Ki Lee, M.D.²

¹Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea

²Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Won Ki Lee, M.D. Department of Ophthalmology, Gangnam St. Mary's Hospital, College of Medicine #505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea Tel: 82-2-590-2758, Fax: 82-2-599-7405, E-mail: wklee@catholic.ac.kr

Received 17 April 2007 Accepted 28 August 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the results of single or combined treatment methods administered to patients with stage 1 retinal angiomatous proliferation (RAP).

Methods

A retrospective clinical study was performed in 9 eyes of 8 patients with stage I RAP. According to fundus angiography findings taken regularly after treatment, the results were categorized as closure of stage 1, recurrence of stage 1, or progress to stage 2.

Results

The mean follow-up period was 25 (14∼40) months. In two eyes treated with laser photocoagulation only, the lesions progressed to stage 2. In two eyes treated with laser photocoagulation and intravitreal triamcinolone injection, the lesions also progressed to stage 2. In four eyes treated with photodynamic therapy and intravitreal triamcinolone injection, stage 1 lesions recurred in 3 eyes, and the lesion progressed to stage 2 in one eye. In one eye treated with photodynamic therapy, intravitreal triamcinolone injection, and laser photocoagulation, the stage 1 lesion recurred. Final visual acuity was stable in the case of stage 1 recurrence but was lower than the pretreatment level when the lesion progressed to stage 2.

Conclusions

With either single or combined therapy, temporary closure of the stage 1 RAP lesion was possible, but complete closure could not be achieved for a long period because the lesion either recurred or progressed.

Keywords: Intravitreal triamcinolone injection, Laser photocoagulation, Photodynamic therapy, Retinal angiomatous proliferation, Stage 1

References

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Figure 1.

Case 4: A 71-year-old female patient with stage 1 retinal angiomatous proliferation (RAP) in the right eye. Visual acuity was 0.63. (A) Baseline fundus photograph showed multiple soft drusens and extrafoveal superficial intraretinal hemorrhage (arrow). (B) Baseline late phase indocyanine green angiogram (ICGA) showed a hyperfluorescent lesion (arrow) at the site of retinal hemorrhage corresponding to stage 1 RAP. After direct laser photocoagulation and intravitreal triamcinolone injection, there was no exudation. (C) One year after treatment, fundus photograph showed newly developed superficial intraretinal hemorrhage (arrow) with old laser photocoagulation scar (arrowheads) inferiorly. (D) Late phase ICGA also showed new lesion (arrow) representing stage 1 RAP recurrence. The second laser photocoagulation at the new lesion was performed. (E) After second treatment, RAP lesion disappeared on ICGA for one year. (F) One year after second treatment, fundus photograph showed large retinal pigment epithelial tear (arrowheads) at the superotemporal area of the macula. Visual acuity was 0.32.

Figure 2.

Case 7: A 77-year-old female patient with stage 1 retinal angiomatous proliferation (RAP) in the right eye. Visual acuity was 0.2. (A) Baseline mid-phase indocyanine green angiogram (ICGA) showed a RAP lesion (arrow) with retinal-retinal anastomosis (arrowheads) corresponding to stage 1 RAP. (B) After one session of photodynamic therapy (PDT) and intravitreal triamcinolone injection (IVTA), late phase ICGA showed no leakage. (C) Five months after first treatment, late phase ICGA showed recurred RAP lesion (arrow) at previous lesion. (D) After second session of PDT and IVTA, recurred lesion disappeared. (E) Six months after second treatment, late phase ICGA showed recurred lesion (arrow) at previous lesion again. (F) After third session of PDT and IVTA, the recurred lesion disappeared. Visual acuity was 0.25.

Table 1.

Clinical characteristics and treatment results of the patients with stage 1 retinal angiomatous proliferation (RAP)

Case	Age/Sex	Initial Examination		Treatments for RAP 1 (numbers)	Closure of initial RAP 1	Location of RAP 1 Recurrence	Progression to RAP 2		Treatments for RAP 2 (numbers)	Follow-up (month)	Final Examination
Case	Age/Sex	VA	Status of Fellow eye	Treatments for RAP 1 (numbers)	Closure of initial RAP 1	Location of RAP 1 Recurrence	Interval (month)	VA	Treatments for RAP 2 (numbers)	Follow-up (month)	VA	Final Status
1	58/F	20/25	RAP 2	L (1)	Yes	New	2	20/125	L (4), P+I (2), S (1)	39	20/400	D scar
2	73/F	20/40	RAP 3	L (1)	Yes	New	6	20/400	−	40	20/400	D scar
3	67/F	20/30	D scar	L+I (1)	Yes	New	5	20/160	P+I (1)	24	20/400	D scar, RPE tear
4	71/F	20/32	D scar	L+I (1), L (1)	Yes	New	26	20/40	−	29	20/60	RPE tear
5	68/F	20/50	RAP 1	P (1), P+I (1)	Yes	New	5	20/80	P+I (1)	10	20/400	RAP 2
6	68/F	20/50	RAP 1	P+I (2)	No	Same	−	−	−	14	20/100	RAP 1
7	77/F	20/100	D scar	P+I (3)	No	Same	−	−	−	18	20/80	RAP 1
8	66/F	20/200	Drusen	P+I (5)	Yes	New	−	−	−	15	20/50	RAP 1
9	80/F	20/125	RPE tear	L+P+I (1), P+I (1)	Yes	New	−	−	−	14	20/60	RAP 1

VA=visual acuity; Interval=interval between RAP 1 to RAP 2; L=laser photocoagulation; L+I=combination therapy of laser photocoagulation and intravitreal triamcinolone injection; P=photodynamic therapy; P+I=combination therapy of photodynamic therapy and intravitreal triamcinolone injection; L+P+I=combination therapy of laser photocoagulation, photodynamic therapy, and intravitreal triamcinolone injection; S=surgical ablation via pars plana vitrectomy; D scar=disciform scar.

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