Retinal Angiomatous Proliferations as a Rare Form of Age Related Macular Degenerations

Abstract

Retinal angiomatous proliferations (RAP) are one rare exudative maculopathy, occurring only in 10% of all cases of age-related macular degeneration (AMD). Objective: The aim of our survey was to describe a rare clinical case of RAP with bilateral affection and discuss the diagnostic methods and possible clinical therapies. Material and methods: We present a case of a 73-year-old patient with bilateral occurrence of RAP examined and followed at Eye Clinic of Military Medical Academy, Sofia. He underwent a complete ophthalmologic examination, including visual acuity, Amsler test and fluorescein angiography. Optical coherence tomography (OCT) was also done with the spectral OCT device RTVue OPTOVUE. The standard retinal programs – HD Line, 3D Macular Test and MM5 quantitative retinal assessment tests have been used. Results: The visual acuity of the patient on his first visit was 20/10 for the right eye, and 20/50 for the left eye, with drusen and significant edema in the posterior pole. On the fluorescein angiographic pictures, intraretinal proliferations were found in the left eye and retino-choroidal anastomoses in the right one. The ОСТ examination confirmed the diagnosis of RAP and enabled us to establish the stage of the disease. In the left eye, the intraretinal proliferations did not involve the subretinal space, so this was RAP I. While in the right eye connections between the retinal and choroidal vessels were seen, as well as serous detachment of the RPE – RAP stage III. We used anti-VEGF therapy in the right eye. Conclusion: Retinal angiomatous proliferations represent an exudative maculopathy, with specific FA and OCT characteristics, differing it from the typical age related macular degeneration. Precise diagnosis and stages of the disease are possible to establish only with the help of optical coherence tomography. RAP is an illness, which, due to its specific pathogenesis, clinical picture and bilateral affection, has to be carefully diagnosed, and monitoring of both eyes has to be taken in consideration.