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Iuri Golubev, Anh-Danh T. Phan; Passive Subretinal Space Associated With Retinal Pigment Epithelium Detachment As False Positive For Exudative Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5144.
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Modern understanding indicates that signs of subretinal fluid (SRF) associated with age-related macular degeneration (AMD) warrant its treatment to prevent any possible vision loss. The purpose of this study is to present a case series of subjects with history of exudative AMD having retinal pigment epithelium detachment (PED) with adjacent SRF, switched to observation alone with no adverse visual or anatomical result. No change of visual acuity or OCT/FA would suggest absence of leakage, as well as an elevation artifact of the retina due to PED without any exudation present within those spaces.
IRB-approved retrospective, comparative chart and diagnostic testing review of three subjects with AMD and subfoveal PED (serous or fibrotic). All subjects showed PED-associated pooling of contrast on fluorescein angiography (FA) without leakage, as well as adjacent SRF on OCT. All subjects were previously considered exudative AMD due to SRF; two were treated with intravitreal anti-VEGF therapy. Snellen visual acuity (VA) and Stratus/Spectral Domain OCT/FA were measured on each visit. Comparisons between baseline (time of stopping treatment) and each follow-up visit were performed. Primary outcome measure was mean Snellen letter change. Secondary outcome measure was macular anatomical change, both central foveal thickness (CFT) and perifoveal thickness (PFT).
Follow-up ranged from 6 to 12 months without anti-VEGF treatment. All subjects demonstrated stable clinical examination of AMD disease. All subjects displayed stable/improved VA and OCT/FA parameters at follow-up visits. One subject showed resolution of SRF after surgical removal of overlying epiretinal and internal limiting membrane. VA improved with hyperopic correction.
Subjects with AMD demonstrating PED with adjacent SRF but without FA leakage can be observed without any treatment. There is little known about the pliability of the retina and whether it can follow the PED contour. It is possible that this artifactual "retinal drape" represents an elevation of retinal layers due to protrusion of the PED or a taut epiretinal surface. This new information suggests that subjects with such clinical scenario actually may not have exudative AMD, can continue to be observed with repeated OCT/FA testing, and not require treatment. Extended data will be presented at the meeting.
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