http://www.evrs.eu/medias/2006/congress/Treatment of Retinal Angiomatous Proliferation Lesions Associated-with-Pigment-Epithelial-Detachment-with-Focal-Pulsed-Laser.swf

Robert P. Murphy, MD (Fairfax, VA), Marissa Albano, MD (Washington, DC), William L. Gilmer, MD (Washington, DC), Lisa Ahramjian, BS (Washington, DC)

PURPOSE:

To demonstrate that retinal angiomatous proliferation (RAP) lesions associated with pigment epithelial detachments (PED) can be diagnosed with indocyanine green angiography (ICG-A) video angiography. To evaluate focal pulsed laser treatment as the primary therapy for inner RAP lesions associated with PEDs defined by video ICG-A and fluorescein angiography (FA).

METHODS:

Retrospective chart review of consecutive patients with at least six months of follow-up who had PED associated with RAP. Eyes with any choroidal neovascularization (CNV) were excluded. After ICG-A identification and lesion localization, treatment was completed with confluent pulsed 532 nm laser applications (spot sizes 75–200 microns.) Treatment endpoint was the development of a mild inner retinal gray lesion. Major outcome variables included visual acuity, closure of RAP lesions, and resolution of the PED. 46 eyes from 41 patients were included. 85% were female. Mean age was 80.4 years. Mean baseline VA was 44 ETDRS letters (Snellen = 20/130).

RESULTS:

In this series RAP could not be diagnosed by FA alone, but required ICG-A for confirmation. 67% presented on FA as pure PED and 26% presented as PED with occult CNV. On ICG all eyes had small (100–400 micron) lesions in the inner retina overlying  the PED. There were no treatment complications. 78% required no further laser treatment after 9 months. The mean ETDRS loss at 6 months was 4 letters; at 12 months 9 letters. 83% had stable or improved visual acuity at 6 months; 64% had stable or improved visual acuity at one year. At 6 months 43% of the PEDs had resolved; by one year, 87% had resolved. 77% of the RAP
lesions remained closed at one year. Approximately 20% of lesions failed to respond to initial treatment; response failure could be associated with progression to CNV.

CONCLUSION:

For these lesions, early ICG-A identification and focal pulsed laser treatment was a safe, effective initial treatment strategy for the majority. Closing the RAP lesion is usually associated with resolution of the PED, suggesting that leakage from RAP may cause the PEDs. Earlier supplemental therapy, when needed, with either photodynamic therapy or anti-VEGF agents may improve results.