A 73 years old male decrese of his VA(OD) PMH=HTN/IHD/Thyroid disorder/BPH POH=cataract surgery(OU)→1389 DH=Triamsulusin

OD OS BCVA FC2M 4/10 RAPD NEG IOP 16 Cornea clear AC D/C Iris ok Lens PCIOL

What’s your next step?

What’s your next step?

What’s your DX? RAP

What’s your treatment? IVB

Staging of RAP(Yannuzi et al) Fundus appearance FA ICG Stage I*(IRN) Small retina HX+small elevation of inner retina Hyperfluorescence in front of RPE+retino-retinal anastomoses Hot spot+staining+ leakage Stage II Involvement of subretinal space +localized PED+edema+HX Diffuse leakage+PED Hot spot+leakage Stage III CNV±vascularized PED

Staging of RAP(Gass) Fundus appearance Preclinical stage Atrophy of outer retina+retinal capillaries moving closer to a CNV complex+no clinical signs of chorioretinal anastomoses(type 1 CNV) Early clinical signs Anastomoses between dilated capillaries of deep retina and CNV+small intraretinal HX Proliferation of CNV over the RPE Subretinal neovascularization(type 2 CNV) Appearance of serous PED caused by activation of newly formedsubepithelial vessels Mixed neovascularization Type 1 and 2 CNV+cicatricial disciform lesion

Following lesions suggest RAP in AMD I)Small multiple Hx(pre,intra,subretinal)normally not observed in macular neurosensory detachments with CNV II)Tortuous,dilated retinal vessels±retino retinal anastomoses III)Telangiectasia IV)Sudden disappearance of a retinal vessel that appears to have moved deeper V)Hard exudates around the retinal lesion

Treatment Thermal laser Sugical ablation PDT Antiangiogenic agents