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Serous Pigment Epithelial Detachment.



-Retinal pigment epithelial detachments (PEDs) are characterized by separation between the RPE and the inner most aspect of Bruch's membrane.


PATHOGENESIS:

- PED from the inner collagenous layer of Bruch's membrane is caused by disruption of the physiological forces maintaining adhesion.

- MOA: Reduction of hydraulic conductivity of a thickened and dysfunctional Bruch's membrane, impending movement of fluid from RPE to the choroid.


TYPES:

-Serous.

-Fibrovascular.

-Drusenoid.

-Hemorrhagic.


PICTURE ABOVE SHOWS A SEROUS PED.


SYMPTOMS:

- Blurred central vision.

- Metamorphopsia.


SIGNS:

-Orange dome-shaped elevation with sharply delineated edges, with a paler margin of SRF.

-Multiple lesions can occur.

-Associated pigment band (indicates chronicity).

-Associated blood, lipid exudation, chorioretinal folds or irregular SRF may indicated underlying CNV.

-If no drusen are seen, suspect PCV.


On FFA:

-Well demarcated oval area of hyperfluorescent pooling that increases in intensity but not in size.


On ICGA:

-Oval hypofluorescent area with surrounding hyperfluorescent ring.


On OCT:

-Separation of RPE from Bruch's membrane by an optically empty area.


COURSE OF THE DISEASE:

- Persistence with increasing atrophy and gradually worsening vision.

- Patients>60 years have worse prognosis.

- Resolution leaving GA with visual loss.

- RPE tear or haemorrhage from CNV can occur with sudden visual loss.


MANAGEMENT:

- Observation in clinically stable patients without readily detectable CNV.

- Anti VEGF.

- PDT + Anti VEGF / IVTA.


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