Tsai Andrew S H, Cheung Ning, Gan Alfred T L, Jaffe Glenn J, Sivaprasad Sobha, Wong Tien Yin, Cheung Chui Ming Gemmy
Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
Singapore Eye Research Institute, Singapore.
Surv Ophthalmol. 2017 Jul-Aug;62(4):462-492. doi: 10.1016/j.survophthal.2017.01.008. Epub 2017 Feb 9.
Retinal angiomatous proliferation (RAP) is a unique variant of neovascular age-related macular degeneration. Published studies have estimated that up to 15% of patients with neovascular age-related macular degeneration have RAP. Clinical features frequently associated with RAP include bilateral disease, presence of pigment epithelial detachments, and reticular pseudodrusen. RAP is more frequently associated with the development of retinal pigment epithelial tears and geographic atrophy that can lead to severe vision loss. Recent advances in retinal and choroidal imaging technology have furthered our understanding of RAP. Although indocyanine green angiography remains the gold standard diagnostic tool, optical coherence tomography has improved the precision by which neovascular age-related macular degeneration with RAP lesions can be diagnosed, staged, and monitored. Anti-vascular endothelial growth factor therapy is currently the first line of treatment. Other treatment options including combination of photodynamic therapy with antiangiogenic agent intravitreal injections or corticosteroids may also achieve a reasonable therapeutic outcome; however, RAP may portend a more guarded visual prognosis than typical choroidal neovascularization because of variable treatment response and dependence on the disease stage. Future basic and clinical research is needed to clarify the pathophysiology, definition and classification, optimal treatment regimen, and long-term outcome of RAP.
视网膜血管瘤样增殖（RAP）是新生血管性年龄相关性黄斑变性的一种独特变体。已发表的研究估计，高达15%的新生血管性年龄相关性黄斑变性患者患有RAP。与RAP经常相关的临床特征包括双侧疾病、色素上皮脱离的存在以及网状假性玻璃膜疣。RAP更常与视网膜色素上皮撕裂和地图样萎缩的发生相关，这可导致严重视力丧失。视网膜和脉络膜成像技术的最新进展加深了我们对RAP的理解。尽管吲哚菁绿血管造影仍然是金标准诊断工具，但光学相干断层扫描提高了诊断、分期和监测伴有RAP病变的新生血管性年龄相关性黄斑变性的精度。抗血管内皮生长因子疗法目前是一线治疗方法。其他治疗选择，包括光动力疗法与抗血管生成剂玻璃体腔内注射或皮质类固醇联合使用，也可能取得合理的治疗效果；然而，由于治疗反应的变异性和对疾病阶段的依赖性，RAP的视觉预后可能比典型的脉络膜新生血管更不乐观。需要未来的基础和临床研究来阐明RAP的病理生理学、定义和分类、最佳治疗方案以及长期结果。
