Korean J Ophthalmol.  2013 Oct;27(5):351-360. 10.3341/kjo.2013.27.5.351.

Characteristic Findings of Optical Coherence Tomography in Retinal Angiomatous Proliferation

• Lim EH
• Han JI
• Kim CG
• Cho SW
• Lee TG

• KMID: 1707289
• DOI: http://doi.org/10.3341/kjo.2013.27.5.351

Abstract

PURPOSE
To identify the unique pathologic findings of retinal angiomatous proliferation (RAP) in optical coherence tomography (OCT).
METHODS
Retrospectively, 29 eyes of 25 patients with age-related macular degeneration and complicated RAP were analyzed. All 29 eyes had choroidal neovascularization (CNV) in the area of pigment epithelial detachment (PED) or adjacent to it, which was visible with fluorescein angiography or indocyanine green angiography. Cross-sectional images were obtained by OCT scanning through the CNV lesions.
RESULTS
Six distinctive findings of OCT included drusen (100%), inner retinal cyst (80%), outer retinal cyst (68%), fibrovascular PED (84%), serous retinal detachment (40%), and PED (68%).
CONCLUSIONS
Through analysis of OCT findings, we revealed six different types of lesions distinctive of RAP which may provide helpful diagnostic information for subsequent treatment and predicting the prognosis of RAP.

Keyword

Fibrovascular pigment epithelial detachment; Inner retinal cyst; Optical coherence tomography; Retinal angiomatous proliferation

MeSH Terms

Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Macular Degeneration/*complications/diagnosis
Male
Middle Aged
Reproducibility of Results
Retina/*pathology
Retinal Neovascularization/*diagnosis/etiology
Retrospective Studies
Severity of Illness Index
Tomography, Optical Coherence/*methods

Figure

• 

  Fig. 1 A 66-year-old man with retinal angiomatous proliferation. (A) Fundus photograph showing drusen, which appears as: confluent yellowish spots on the macula (red arrow). (B) Fluorescein angiogram revealing hyperfluent, ill-defined confluent lesions including focal hyperpigmentation of the macula (arrow). (C) Indocyanine green angiogram showing small drusen, which are mildly hyperfluorescent or not clearly seen (black arrow). (D) Optical coherence tomography scan showing incontiguous elevation of the retinal pigment epithelium (RPE) with slight thickening of RPE/Bruch's membrane complex (dotted arrow).

• 

  Fig. 2 A 54-year-old man with retinal angiomatous proliferation. (A) Fundus photograph revealing a delicate, star-shaped distortion of the macula without prominent cyst formation (red arrow). (B,C) Fluorescein and indocyanine green angiogram demonstrating retinal distortion, though leakage of dye is not found (arrows). (D) Optical coherence tomography scan showing round, minimally reflective (darker) space spanning nearly the entire thickness of the retina and extending from the retinal pigment epithelium/choriocapillaris reflection to the highly reflective anterior boundary of the neurosensory retina (dotted arrow).

• 

  Fig. 3 A 61-year-old woman with retinal angiomatous proliferation. (A) Fundus photograph showing distortion of the macula with yellowish scar change surrounding a cyst-like lesion (red arrow). (B) Fluorescein angiogram revealing dense hyperfluorescence with diffuse leakage of dye in cystic spaces near, but not inside, the fovea (arrow). (C) Indocyanine green angiogram showing the presence of a RAP, which is classified as an irregular hyperfluorescence with termination of the retinal vasculature (arrow head). (D) Optical coherence tomography scan showing subretinal tissue presumably corresponding to the yellowish scar change visible on the color photo (dotted black arrow). Note the inner retinal cystoid cavities above.

• 

  Fig. 4 A 65-year-old woman with retinal angiomatous proliferation. (A) Fundus photograph showing diffuse, patch-like cystic change underneath the retinal pigment epithelium in the macula (red arrow). (B) Fluorescein angiogram showing small hyperfluorescence with diffuse leakage of dye in the cystic spaces near and inside the fovea with stippled hyperfluorescence beneath the fovea (arrow). (C) Indocyanine green angiogram revealing the presence of a retinal angiomatous proliferation, which is classified as an irregular hyperfluorescence (black arrow). (D) Optical coherence tomography scan showing two adjacent outer retinal cysts (ORCs) located in a fibrotic area associated with choroidal neovascularization, which is surrounded by a hyperreflective border (dotted arrow). Note the differences between the ORCs and the inner retinal cystoid cavities above.

• 

  Fig. 5 A 55-year-old woman with retinal angiomatous proliferation. (A) Fundus photograph showing distortion of the macula with yellowish patch-like lesions surrounded by broad cystic change (red arrow). (B) Fluorescein angiogram revealing dense hyperfluorescence with diffuse leakage of dye mimicking choroidal neovascularization in the macula. A large cystic lesion lies inferotemporally, but cannot be clearly seen (arrow). (C) Indocyanine green angiogram showing a more prominent boundary of cystic space below the macula (black arrow). (D) Optical coherence tomography scan indicating subretinal fluid (dotted arrow) adjacent to the subretinal tissue.

• 

  Fig. 6 A 64-year-old woman with retinal angiomatous proliferation. (A) Fundus photograph showing a serous retinal pigment epithelium detachment and subretinal hemorrhage (red arrow). (B,C) Fluorescein and indocyanine green angiogram showing dye leakage from choroidal neovascularization within the retinal pigment epithelial detachment (arrow and arrowhead). (D) Optical coherence tomography scan revealing the dome-shaped elevation of a highly reflective layer corresponding to the detached retinal pigment epithelium (dotted arrow).

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