Retinal Angiomatous Proliferations: When Should We Suspect Them and How Should We Detect Them?

Background: The aim of this study was to identify the clinical and angiographic features of retinal angiomatous proliferations (RAPs) in patients with age-related macular degeneration. Patients and Methods: 26 eyes of 24 patients with RAPs were retrospectively reviewed. All patients had colour and red-free photographs, and fluorescein (FA) and indocyanine-green angiography (ICGA). The biomicroscopic and angiographic characteristics were evaluated and video-angiograms were analysed for staging the RAPs. Results: The total number of RAPs was 29. Stage 1 was present in 3/29, stage 2 in 3/29 and stage 3 in 23/29 with a chorio-retinal anastomosis identified in 21 of these 23 eyes. The total number of retinal vessels involved were 83, 35 were arteries and 48 were veins. RAPs were seen in ICGA as hot spots in all but one case where it appeared as a plaque. A retinal pigment epithelial detachment (PED) was observed in 22/26 eyes. Cystoid macular oedema was observed in 13/26 eyes in FA and intraretinal ICG leakage in 6/26 eyes. Hard exudates were present in 21/26 eyes. Retinal haemorrhages were present in 23/26 eyes; all but one were intraretinal and had a size of less than half of the optic disc diameter. The RAP was bilateral in 2/24 patients. Conclusions: Clinicians should suspect the diagnosis of RAP when hard exudates, small intraretinal haemorrhages, PED or a hot spot in ICGA are present. Both fluorescein and ICG video-angiography provide adequate temporal resolution and vascular flow examination leading to easier RAP staging and identification of the anastomosis.