OSLI Retina

March 2020

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136 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Evaluating Retinal Angiomatous Proliferation With Optical Coherence Tomography Angiography Jianbo Mao, MD; Dan Cheng, PhD; Jingjing Lin, MD; Yiqi Chen, MD; Zhe Lv, MD; Lijun Shen, MD BACKGROUND AND OBJECTIVE: To report the imag- ing features of different stages of retinal angioma- tous proliferation (RAP) on optical coherence to- mography angiography (OCTA). PATIENTS AND METHODS: Patients diagnosed with RAP were included in this study. All patients underwent fluorescein angiography (FA), indo- cyanine green angiography (ICGA), optical coher- ence tomography (OCT), and OCTA. The OCTA features were illustrated and compared with FA, ICGA, and OCT. OCTA was performed at baseline and after injection of anti-vascular endothelial growth factor (VEGF). RESULTS: A total of 12 eyes of 12 consecutive pa- tients were included. Patients' ages ranged from 57 to 82 years. In all cases, the hot spot lesions found on FA or ICGA were clearly detected on OCTA in the same area (12/12, 100%). Hot spot lesions showed variable patterns. Four patients had mul- tiple hot spot lesions located on the outer retina layer, deep layer, or superior retinal layer. OCTA showed a clearer location and relationship with feeder vessels compared with FA or ICGA. Eight patients had received anti-VEGF therapy 1.75 ± 1.06 times. Follow-up OCTA images demonstrat- ed smaller and fewer hot spot lesions with lesser blood flow signal. CONCLUSIONS: OCTA is a noninvasive, fast imag- ing modality for detecting microvascular changes, and it provides more detail of the RAP lesion and related vessels than ICGA or FA. OCTA would be a valuable tool for follow-up observation. The OCTA patterns of RAP may be helpful in understanding its pathology. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:136-144.] INTRODUCTION Retinal angiomatous proliferation (RAP), also termed type 3 choroidal neovascularization (CNV), is a distinct neovascular lesion type in age-related mac- ular degeneration (AMD) whose intraretinal patho- logic characteristics differentiate it from type 1 and type 2 CNV. 1,2 With improvement in imaging tech- niques, the incidence of RAP has been reported to be up to 34.2% among eyes with neovascular AMD. 3 RAP has a very poor functional prognosis because it is more likely to develop geographic atrophy than other types of CNV. 4,5 Based on the natural course of this form of neovascularization, patients with RAP are classified into three stages. 1,6 Stage I involves proliferation of intraretinal neovascularization (IRN). The involved vessels extend beneath the neurosen- sory retina to become subretinal neovascularization (SRN), termed stage II, and eventually merge with the choroidal circulation proliferating beneath the retinal pigment epithelium to form a retinal-choroidal anas- tomosis (stage III). The distinct anatomic association introduces the possibility of different treatment strat- egies and visual prognosis during progression. 1,7 To diagnose RAP precisely and to evaluate the efficacy of treatment, determining the composition of the lesion and its location in different stages is essential. Multimodal imaging techniques, including fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical From the Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China. Originally submitted February 28, 2019. Revision received July 20, 2019. Accepted for publication September 10, 2019. This study was supported by research grants from the Platform Key Project of Medical Scientific Research Foundation of Zhejiang Province (2016ZDA016), the Platform Key Project of Medical Scientific Research Foundation of Zhejiang Province (2016ZHB013), the Key Project of The Eye Hospital of Wenzhou Medical University (YNZD201003), and the Medical Key Subject of Zhejiang Province (2016CXXK2). The authors report no relevant financial disclosures. Address correspondence to Lijun Shen, MD, Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zheji- ang Province, China; email: slj@mail.eye.ac.cn. doi: 10.3928/23258160-20200228-02

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