Retinal Pigment Epithelial Detachment in Age-Related Macular Degeneration

Abstract

Retinal pigment epithelial detachment is defined as a separation of the retinal pigment epithelium from the inner collagenous layer of Bruch's membrane. It is a common manifestation in both dry and wet types of age-related macular degeneration. This review aims to provide a comprehensive guide to the pathophysiology, clinical and imaging characteristics, natural course and treatment of the various types of pigment epithelial detachments in order to assist in diagnosis and management of this important feature of age-related macular degeneration.

Keywords: Age-related macular degeneration; Drusenoid; Fibrovascular; Haemorrhagic; Pigment epithelial detachment; Serous.

Fig. 1

Serous PED in a 58-year-old woman. Early, mid- and late phase of ICGA showing hypofluorescence in all phases. Note the absence of a hot spot. Spectral-domain OCT (SD-OCT) did not demonstrate any IRF or SRF

Fig. 2

SD-OCT of a serous PED. The PED appears as a dome-shaped elevation of the RPE (arrow) over a uniform hypo-reflective space. Bruch’s membrane is seen at the base of the PED (arrowhead)

Fig. 3

Drusenoid PED in a 76-year-old woman. Color fundus photograph with multiple soft drusen, RPE changes and a central drusenoid PED. Early, mid- and late phase of FA showing early hyperfluorescence corresponding to the area of drusen and PED as well as late staining with no leakage

Fig. 4

Serial SD-OCT scans of a 68-year-old woman with soft drusen and an adjacent hypo-reflective space who was followed up for 3 years. OCT scans were taken on yearly intervals. Note the gradual coalescence of soft drusen and the development of a drusenoid PED. The PED has a homogenous, mildly hyper-reflective interior, and Bruch’s membrane is seen at its base. During the observation period the hypo-reflective space and visual acuity remained stable

Fig. 5

Occult CNV in a 76-year-old woman. Early, mid- and late frames of FA demonstrating stippled hyperfluorescence in mid- and late phases. SD-OCT shows an irregular elevation of the RPE with a non-uniform hyper-reflective interior. There is also mild SRF and hyper-reflective foci in the neuroretina

Fig. 6

IPCV in a 70-year-old man. Early, mid- and late phase of ICGA showing the polyp (arrowhead) as well as associated branching vascular network (arrow) that is more clearly delineated on en-phase OCTA (lower right panel). Cross-sectional OCTA demonstrates a steep, convex PED with non-uniform hyper-reflective interior, vascular flow at its apex and surrounding SRF

Fig. 7

SD-OCT scans of different cases of fibrovascular PEDs. Note the irregular elevation of the RPE, the inhomogeneous hyper-reflective interior, and the presence of SRF (top, bottom) as well as hyper-reflective neuroretinal foci (top, bottom)

Fig. 8

Fibrovascular PED in an 89-year-old woman who had anti-VEGF treatment despite the absence of SRF or IRF in cross-sectional OCTA. Early and late phases of FA showing mild late staining. En-phase OCTA shows the CNV, which in this case demonstrates signs of maturity (prominent trunk vessels, pruning). This case was considered a “silent CNV” due to the absence of exudative signs throughout follow-up