-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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