视网膜血管瘤增殖一年龄相关性黄斑变性的特殊类型

本文总结了年龄相关性黄斑变性的特殊类型—视网膜血管瘤增殖(RAP)的临床和造影表现及分期。RAP是起源于黄斑旁视网膜深层毛细血管的、以伴发多灶小片视网膜内出血及盘变前期即有视网膜-脉络膜血管吻合(RCA)形成为特征的新生血管性AMD。     

视网膜血管瘤性的增生 光学相干断层检查证实的一个视网膜内病灶

视网膜血骨瘤增生逐渐被认识到是年龄相关性黄斑变性中新生血管的一种变异。视网膜血管瘤性增生被认为是视网膜内新生血管芽。这些血管芽长入视网膜下腔导致浆液性视网膜色素上皮脱离并且可以与脉络膜新生血管吻合。我们报道1例视网膜视网膜血管瘤性的增生合并浆液性视网膜色素上皮脱离．通过光学相干断层扫描（OCT）证实有视网膜内新生血管。     

药物治疗视网膜下新生血管的研究进展

视网膜下新生血管(subretinal neovascularization，SRNV)也称为脉络膜新生血管(choroidal neovascularization，CNV)，是由多种病因所致的脉络膜新生血管穿越Bruch膜并在视网膜色素上皮下和(或)视网膜神经感觉层下增殖形成的纤维血管组织，为导致年龄相关性黄斑变性(age-related macular     

年龄相关性黄斑变性视网膜血管瘤性增生的治疗 104例视网膜血管瘤性增生病例

目的：视网膜血管瘤性增生（RAP）是新近描述的一种在年龄相关性黄斑变性患者的视网膜内出现的新生血管性病灶，本文主要报道控制视网膜血管瘤性增生（RAP）的治疗措施。     

氪红激光透热治疗视网膜下新生血管及脉络膜血管瘤的疗效分析

目的：观察用氪红激光大光斑，低能量，长时间照射眼底视网膜下新生血管（SRNV）及脉络膜血管瘤的治疗效果。方法：选用经临床眼底检查，FFA检查（部分作ICG检查）证实的视网膜下新生血管病例20例。其中渗出型增龄性黄斑变性（AMD）14例。高度近视黄斑出血4例。中心性渗出性视网膜脉络膜病变（中渗）2例；另有2例孤立性脉络膜血管瘤，使用氪红激光经瞳孔照射病灶部位，所用激光参数为，光斑直径750-1000μm，功率75-100mW，照射时间20-30S，根据病灶范围大小确定激光点数，RNV激射1-6点，平均3点，脉络膜血管瘤激射20-40点不等，术后复查视力，眼底检查，FFA（及ICG）检查，评价治疗效果。结果：22例中有随访记录的18例。随访12例AMD中治愈7例。好转4例。视力下降1例；中渗2例中治愈1例。好转1例；高度近视2例中治愈1例。好转1例；2例脉络膜血管瘤均获治愈。结论：使用大光斑，低能量，长时间氪红激光治疗视网膜下新生血管病变及脉络膜血管瘤。对新生血管的萎缩，保存和恢复视力疗效可靠，副作用小。     

视网膜血管瘤样增生的研究概况

视网膜血管瘤样增生(RAP)是年龄相关性黄斑变性的一种特殊类型,它起源于黄斑旁视网膜深层毛细血管网,并能不断增殖突破视网膜下间隙最终与脉络膜血管吻合.本文就视网膜血管瘤样增生的研究历程、分期、临床表现、诊断及治疗现状作一综述.     

光学相干断层扫描血管成像(OCTA)和荧光素血管造影(FFA)对比观察增生型糖尿病视网膜病变(PDR)

目的 运用光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)和荧光素血管造影(fundusfluorescein angiography,FFA)对比观察增生型糖尿病视网膜病变(proliferating diabetic retinopathy,PDR)的临床特征,分析OCTA与FFA对PDR患眼眼底病变检出的一致性.方法 回顾性病例研究.选择PDR患者25例(36眼),每例患者均行OCTA和FFA检查,并且两项检查间隔时间不超过2h.对比观察记录PDR患眼在OCTA和FFA图像中黄斑拱环结构改变、黄斑水肿、视网膜微血管瘤、视网膜新生血管、视网膜无灌注区5种眼底病变的影像学特征,并分析两种检查方法对上述眼底改变检出的一致性.结果 PDR患眼的OCTA特征主要为黄斑拱环结构改变区视网膜浅层毛细血管扩张迂曲、深层中心凹无血管区扩大,黄斑水肿区视网膜浅层血管迂曲扩张、视网膜深层片囊状弱信号,视网膜微血管瘤区浅层、深层毛细血管局部囊样扩张膨大或梭形改变,视网膜新生血管区浅层、深层不规则异常血管网状结构,视网膜无灌注区片状弱信号;PDR患眼的FFA图像特征主要为黄斑拱环结构改变区周围血管扩张弯曲,黄斑水肿区、视网膜微血管瘤区和视网膜新生血管区造影期强荧光,视网膜无灌注区表现和OCTA相似.OCTA检查发现PDR患眼黄斑拱环结构改变、黄斑水肿、视网膜微血管瘤、视网膜新生血管、视网膜无灌注区分别为26眼、26眼、25眼、13眼、30眼;FFA检查发现5种眼底病变依次为20眼、28眼、28眼、12眼、30眼;OCTA与FFA检查对PDR患眼黄斑拱环结构改变、黄斑水肿、视网膜微血管瘤检出的一致性一般(Kappa=0.416、0.705、0.646,均为P＜0.01),对视网膜新生血管、视网膜无灌注区检出的一致性较好(Kappa=0.816、0.800,均为P＜0.01).结论 OCTA与FFA能较好地观察到PDR患眼5种眼底病变,并对PDR患眼的部分眼底病变的检出具有良好的一致性.     

骨桥蛋白与眼部新生血管性疾病研究进展

眼部新生血管是眼部疾病中致盲的主要原因之一.常见的致盲眼病,如糖尿病视网膜病变、年龄相关性黄斑变性、感染性角膜炎等均与新生血管存在一定的关系.骨桥蛋白（OPN）是一种能够促进血管再生与组织修复的糖蛋白,在角膜、脉络膜和视网膜新生血管中表达增多,能够促进新生血管的发生.OPN与新生血管的关系为新生血管性疾病的研究和治疗提供了新的方向.从OPN促进角膜新生血管、脉络膜新生血管、视网膜新生血管生成3个方面对OPN与眼部新生血管性疾病的关系研究进展进行综述.     

血管内皮生长因子与视网膜新生血管性疾病

血管内皮生长因子（ＶＥＧＦ）是新近确定的一种特异性刺激血管内皮细胞增殖及新生血管形成的生长因子。视网膜血管内皮细胞存在ＶＥＧＦ高亲和受体，而且受体数目较其它组织内皮细胞多。ＶＥＧＦ的特点是它的表达受局限部氧浓度的调节。视网膜血管内皮细胞、色素上皮细胞、周皮细胞、Ｍｕｅｌｌｅｒ细胞均能合成并分泌ＶＥＧＦ，缺氧可上调其基因表达。ＶＥＧＦ既可刺激视网膜血管内皮细胞增殖及移行，也可诱导视网膜新生血管形成。     

视网膜血管瘤样增生的诊断与治疗

视网膜血管瘤样增生(retinal angiomatous proliferation,RAP)是湿性老年性黄斑变性(age-related macular degeneration,AMD)隐匿性新生血管的另一种病变形式,起源于黄斑旁视网膜深层毛细血管层,以多发性小灶状视网膜内出血、视网膜色素上皮脱离(pigment epithelial detachment,PED)、视网膜-脉络膜血管吻合(retinal-choroidal anastomosis,RCA)为特点,对视力损害严重。本文对近年来的有关文献进行复习,并就RAP的发病机制、临床分期、诊断特点、治疗及预后进行综述。     

Retinal angiomatous proliferation responds safely to a double dose (1.0 mg) of ranibizumab

A 77‐year‐old man presented with sudden foggy central vision in the right eye. The visual acuity (VA) was 6/60 (R) and 6/6 (L). Funduscopy revealed superficial macular haemorrhage in the right eye. Using fluorescein angiography and indocyanine green angiography, retinal angiomatous proliferation was confirmed. Two intra‐vitreal injections of bevacizumab were given but the VA did not improve. Following this, he received an intra‐vitreal injection of ranibizumab. Regression of the retinal angiomatous proliferation was observed and the VA of the right eye returned to 6/10. Simultaneously, his left eye suffered from sudden visual loss and retinal angiomatous proliferation was diagnosed. Three intra‐vitreal injections of ranibizumab were given. Regression of the retinal angiomatous proliferation was observed and the VA of the left eye was stabilised. Another 80‐year‐old man complained of sudden distorted vision in his left eye. Funduscopy and optical coherence tomography (OCT) revealed superficial macular haemorrhage and retinal pigment epithelial detachment (RPED). The VA was 6/12 and retinal angiomatous proliferation was diagnosed. He received an intra‐vitreous injection of bevacizumab followed by photodynamic therapy (PDT). The RPED was resolved; however, the VA dropped to 2/60. Optical coherent tomography, fluorescein angiography and indocyanine green angiography were used to indentify retinal angiomatous proliferation. Intra‐vitreal injection(s) of a double dose (1 mg) of ranibizumab is a worthwhile treatment, as it can stabilise and even improve the VA without significant side effects.     

Retinal angiomatous proliferation not associated with age-related macular degeneration. Favourable outcome after photodynamic therapy

CASE: A 55-year-old male was diagnosed with exudative-hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome. DISCUSSION: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD     

与年龄相关性黄斑变性有关的细胞外沉积：视网膜下疣样沉积和网状假性玻璃膜疣

 脂蛋白来源的碎片等沉积物可沉积于视网膜光感受器和色素上皮细胞之间,称为网状假性玻璃膜疣或视网膜下疣样沉积。临床上非常常见,但易被误认为是玻璃膜疣。网状假性玻璃膜疣与III型脉络膜新生血管、外层视网膜萎缩等较为密切。（眼科,2022,31： 413-418）     

Successful Treatment of Retinal Angiomatous Proliferation with Intravitreal Triamcinolone and Ranibizumab Injections in a 67-Year-Old Male

A 67-year-old male who presented to the eye casualty department with deterioration in his vision was diagnosed with retinal angiomatous proliferation. After initial deterioration with ranibizumab intravitreal injections, we have demonstrated successful treatment and stabilised vision with ranibizumab and a single intravitreal triamcinolone injection. Stringent follow-up and top-up ranibizumab injections have stabilised his vision and have shown foveal improvement on optical coherence tomography imaging.Key words: Retinal angiomatous proliferation, Neovascularisation, Triamcinolone, Ranibizumab, Retina, Age-related macular degeneration     

Retinal angiomatous proliferation in age-related macular degeneration

BACKGROUND: It is known that choroidal neovascularization (CNV) in age-related macular degeneration (ARMD) may erode through the retinal pigment epithelium, infiltrate the neurosensory retina, and communicate with the retinal circulation in what has been referred to as a retinal-choroidal anastomosis (RCA). This is extremely common in the end stage of disciform disease. In recent years, the reverse also seems to be possible, as angiomatous proliferation originates from the retina and extends posteriorly into the subretinal space, eventually communicating in some cases with choroidal new vessels. This form of neovascular ARMD, termed retinal angiomatous proliferation (RAP) in this article, can be confused with CNV. PURPOSE: The purpose of this article is 1) to review the clinical and angiographic characteristics of a series of patients with RAP and 2) to propose a theoretical sequence of events that accounts for the neovascularized process. METHODS: In this retrospective clinical and angiographic analysis, 143 eyes with RAP (108 patients) were reviewed and classified based on their vasogenic nature and course. Clinical biomicroscopic examination, fluorescein angiography, and indocyanine green angiography were used to evaluate patients. RESULTS: The results of this series suggest that angiomatous proliferation within the retina is the first manifestation of the vasogenic process in this form of neovascular ARMD. Dilated retinal vessels and pre-, intra-, and subretinal hemorrhages and exudate evolve, surrounding the angiomatous proliferation as the process extends into the deep retina and subretinal space. One or more dilated compensatory retinal vessels perfuse and drain the neovascularization, sometimes forming a retinal-retinal anastomosis. Fluorescein angiography in these patients usually revealed indistinct staining simulating occult CNV. Indocyanine green angiography was useful to make an accurate diagnosis in most cases. It revealed a focal area of intense hyperfluorescence corresponding to the neovascularization ("hot spot") and other characteristic findings. Based on understanding of the nature and progression of the neovascularized process, patients with RAP were classified into three vasogenic stages. Stage I involved proliferation of intraretinal capillaries originating from the deep retinal complex (intraretinal neovascularization [IRN]). Stage II was determined by growth of the retinal vessels into the subretinal space (subretinal neovascularization [SRN]). Stage III occurred when CNV could clearly be determined clinically or angiographically. A vascularized pigment epithelial detachment and RCA were inconsistent features of this stage. CONCLUSIONS: Retinal angiomatous proliferation appears to be a distinct subgroup of neovascular ARMD. It may present in one of three vasogenic stages: IRN, SRN, or CNV. Whereas ICG angiography is helpful in diagnosing RAP and in documenting the stage of the neovascularized process, it is frequently difficult to determine the precise nature and location of the new vessel formation. It is important for clinicians to recognize the vasogenic potential and the associated manifestations of this peculiar form of neovascular ARMD so that a proper diagnosis can be made, and when possible, an appropriate management administered.     

A new treatment regimen in combined intravitreal injection of triamcinolone acetonide and photodynamic therapy

BACKGROUND: Combined photodynamic therapy (PDT) and intravitreal injection of triamcinolone acetonide is a new option in the treatment of the neovascular form of age-related macular degeneration. With the aim of increasing safety and efficacy we examined whether it is possible to administer the intravitreal injection prior to PDT. METHODS: Patients with retinal angiomatous proliferation, who have an unfavourable prognosis when treated with PDT alone, were recruited to this study. Intravitreal injection of triamcinolone acetonide was applied 1 day before PDT. Distance acuity testing, retinal thickness measurement and fluorescein angiography were performed before treatment and 6 weeks and 3 months thereafter. RESULTS: Twenty-five patients were included: 18 were female, 7 male. Their mean age was 79 years. The distance acuity was 68 letters before treatment and at the follow-up examinations. The retinal thickness decreased significantly from mean 470.8 microm to 335.4 microm at week 6 and 360.8 microm at month 3. At month 3, 48% showed signs of activity in the fluorescein angiography needing retreatment. Visualisation of the fundus was not reduced by the triamcinolone crystals. DISCUSSION: PDT was possible without difficulty after intravitreal injection of triamcinolone acetonide. Stabilisation of the visual acuity was possible, although only eyes with retinal angiomatous proliferation were included.     

Retinal angiomatous proliferation with a cilioretinal artery anastomosis: an unusual presentation

Purpose To report an unusual phenotype of retinal angiomatous proliferation (RAP) in age-related macular degeneration (AMD) and its short-term response to laser photocoagulation.Methods Case report.Results An 85-year-old woman was found to have an unusual RAP with a major feeder vessel originating from a cilioretinal artery and associated with a cilioretinal–retinal anastomosis (C-RRA). Diffuse cystoid macular edema (CME), intraretinal hard exudates in a circinate pattern, and a fibrovascular pigment epithelial detachment (PED) were present. Laser photocoagulation was performed and led to occlusion of the cilioretinal feeder vessel and angiomatous lesion, with less CME. The other (retinal) arm of the C-RRA became more engorged and a new cilioretinal feeder developed, and both were associated with intraretinal hemorrhages. Visual acuity was stable and the PED persisted throughout follow-up.Conclusions We report an unusual phenotype of RAP that is associated with a major cilioretinal feeder vessel and comment on the possible effect of such an association on the response to laser treatment.     

The nature and frequency of neovascular age-related macular degeneration

PURPOSE: This study was designed to evaluate the frequency and nature of neovascularization in age-related macular degeneration (ARMD) utilizing the combination of digital imaging techniques, fluorescein angiography (FA), indocyanine green (ICG) angiography, and optical coherence tomography (OCT). METHODS: A complete clinical examination was performed on 100 eyes of 93 consecutive newly diagnosed patients with neovascular ARMD. Digital fluorescein angiography, ICG angiography, and OCT were also used in evaluating those patients. Comparison of the imaging techniques to determine their value in studying the nature of the lesions. RESULTS: On the basis of existing fluorescein standards, 15 eyes were diagnosed with classic choroidal neovascularization (CNV), 15 with minimally classic CNV, and 70 with occult CNV. ICG angiography was superior for detecting the active vascular component in polypoidal CNV (16 eyes) and retinal angiomatous proliferation (14 eyes). OCT was more sensitive than FA for determining the presence of cystoid macular edema evident in the vast majority of eyes with retinal angiomatous proliferation (RAP). CONCLUSIONS: These results suggest that FA, ICG angiography, and OCT, when used in combination, will assist clinicians in best determining the precise nature of the neovascular process in ARMD.     

Retinal Pigment Epithelium Tear after Vitrectomy for Vitreomacular Traction Syndrome in an Eye with Retinal Angiomatous Proliferation

An 87-year-old Japanese man presented with retinal angiomatous proliferation (RAP) and a retinal pigment epithelium (RPE) detachment in his right eye. His decimal best-corrected visual acuity was 0.15 in the right eye, and optical coherence tomography (OCT) showed a vitreomacular adhesion in the right eye as well. After 3 monthly intravitreal injections of ranibizumab, the size and height of the RPE detachment was significantly reduced. The accumulated intra- and subretinal fluid also disappeared, but the vitreomacular traction remained. Pars plana vitrectomy was performed, and the posterior hyaloid was separated from the retina with a vitrectomy cutter without any intraoperative complications. Two months after the surgery, a large RPE tear was observed over the macular area. His visual acuity decreased to 0.06 and remained unchanged thereafter. We suggest that the small tear led to the larger RPE tear because vitreomacular traction was transmitted to the RPE through the fibrovascular tissue of the RAP during the creation of the hyaloid detachment. Because such an RPE tear has not been reported after vitrectomy for vitreomacular traction, surgeons need to pay special attention to this potential complication in eyes with vitreomacular traction and RAP.Key Words: Retinal angiomatous proliferation, Vitreomacular traction syndrome, Vitrectomy, Retinal pigment epithelium tear