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December 1, 2005

Retinal Anastomosis to Choroidal NeovascularizationA Bum Rap for a Difficult Disease

Arch Ophthalmol. 2005;123(12):1741-1743. doi:10.1001/archopht.123.12.1741

Anastomosis of retinal vessels to lesions of choroidal neovascularization (CNV), especially in age-related macular degeneration (AMD), has been recognized histopathologically1 and given many names when recognized clinically.25 The term chorioretinal anastomosis5 has been used to describe these anastomoses. However, because the retinal vessels may connect to subretinal neovascularization rather than to neovascularization beneath the retinal pigment epithelium, there may be no connection with the choroid. Thus, this term may not be accurate in all cases. The term retinal angiomatous proliferans (RAP), as coined by Yannuzzi et al,3 has become widely accepted to describe these features, as has been done in the article by Bottoni et al6 in this issue of the ARCHIVES. However, this term may not be accurate all of the time. There is no histopathologic correlate to suggest that retinal vessels anastomosing with CNV have angiomalike features, nor has any histopathologic abnormality, to my knowledge, shown proliferation of retinal vessels in the absence of CNV. Recently, the photograph reading center for the Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) investigation and Verteporfin in Photodynamic Therapy (VIP) trial4 used the terms retinal lesion anastomosis or retinal anastomosis to the lesion to describe a retinal vessel anastomosing with a CNV lesion, avoiding the presumption that the lesion was either in the choroid or in the subretinal space.

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