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

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

5. What’s your next step?

8. What’s your next step?

13. What’s your DX?
RAP

14. What’s your treatment?
IVB

15. 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

20. 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

21. 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

22. Treatment
Thermal laser
Sugical ablation
PDT
Antiangiogenic agents