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.
www.ophthalmobytes.com
Image from Rajan Eye Care Hospital
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