gms | German Medical Science

Retinal angiomatous proliferation (RAP) is one subgroup of neovascular age-related macular degeneration. Angiomatous proliferation originates from the retina and extends into the subretinal space. Retinal hemorrhages can complicate the diagnosis of this maculopathy.

A 74-year-old patient was presented after uncomplicated cataract surgery with the diagnosis of a retinal venous branch occlusion of his left eye and a neovascular age-related macular degeneration of his right eye.

At first presentation the best corrected visual acuity was 0,4 on the right and 0,5 on the left eye. On ophthalmoscopy, a hemorrhagic detachment of the pigment epithelium was detected in the right eye. In the left eye, a circumcribed edema of the neurosensory retina with a striate hemorrhage above the fovea and numerous drusen was seen. Fluorescein angiography revealed a detachment of the pigment epithelium and a round diffuse hyperfluorescence superior to the macula on the right eye and a poorly demarcated late hyperfluorescence above the macula on the left eye. There were no dilated vessels or collateral vessels. Indocyanine green angiography showed an early hyperfluorescence (hot spot) consistent with a retinochoroidal anastomosis above the macula in the right eye and a hot spot above the macula in the left eye.

Early changes of the fundus in the area of the RAP are dilated vessels, pre-, intra- and subretinal hemorrhages and exsudates which can be misinterpreted as a retinal venous branch occlusion. Indocyanine green angiography is an important diagnostic tool in differential diagnosis of RAP.