Progression of Retinal Angiomatous Proliferation after Surgical Ablation

ABSTRACT

PURPOSE: To describe the clinical course of three eyes of three patients that underwent surgical ablation as treatment of retinal angiomatous proliferation (RAP). METHODS: Surgical lysis of the retinal feeding arteriole and draining venule was done in two eyes that had stage 2 RAP with serous pigment epithelial detachment (PED). It was done as the first treatment modality in one eye, and after failure of laser photocoagulation in the other. It was also performed in another eye presumed to have very early stage RAP that showed only retinal-retinal anastomosis without any definite intraretinal or subretinal angiomatous lesion. RESULTS: PED decreased within 1 month after ablation in the two eyes with stage 2 RAP, but new anastomoses eventually developed after 1 month, followed by progression of the lesions. In the eye with presumed early stage RAP, successful lysis of retinal-retinal anastomosis was maintained and initially showed no signs of further proliferation at the original lesion site; however, four months later, hemorrhagic PED developed distally and progressed further to retinal pigment epithelial tear and massive subretinal hemorrhage. CONCLUSIONS: Surgical ablation may be unable to halt the progressive nature of neovascular proliferations in RAP.