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Lina M. Rodriguez, Omar S. Punjabi, Lee M. Jampol, Joyce Huang, Alice T. Lyon, Rukhsana G. Mirza; Macular Pigment Epithelial Detachments: Imaging Characteristics and Response to Anti-Vascular Endothelial Growth Factor Therapy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3702.
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To evaluate the imaging characteristics of macular retinal pigment epithelial detachments (PEDs) as well as their response to anti-vascular endothelial growth factor (VEGF) therapy in different types of exudative maculopathies such as age-related macular degeneration (AMD), idiopathic polypoidal choroidal vasculopathy (IPCV), presumed ocular histoplasmosis syndrome (POHS) and central serous retinopathy (CSR) with choroidal neovascularization (CNV).
A retrospective review of 38 eyes of 34 patients with PEDs seen in clinic between 10/09 and 02/10.
Three types of PEDs were visualized based on Optical Coherence Tomography (OCT) appearance and reflectivity: hollow, solid and drusenoid. Hollow PEDs had >50% hypo-reflective signal beneath the lesion on OCT and solid PEDs had >50% hyper-reflective signal beneath the lesion on OCT. Drusenoid PEDs were small excrescences under the RPE in association with CNV and exudative AMD. Subfoveal hollow and all solid PEDs on OCT corresponded to the location of CNV on fluorescein angiography (FA), i.e. the CNV was beneath the PED on OCT, whereas in hollow extrafoveal PEDs the CNV lesion was adjacent to the PED. The average number of anti-VEGF injections was 7 per eye and average duration of follow-up was 16 months. Hollow PEDs flattened in exudative AMD (4/13 eyes) and IPCV (2/2 eyes), but solid (1/11) and drusenoid (0/4) PEDs rarely flattened after anti-VEGF therapy. POHS and CSR with CNV were associated with subfoveal solid PEDs and were unchanged (4/4 in each group) after therapy. Overall, hollow PEDs flattened in 6/15 eyes (4 were >1 disk diameter (DD) in size) and solid PEDs flattened in fewer eyes (1/23, p<0.05). Improvement in vision correlated with decrease in associated intraretinal and subretinal fluid but not with PED flattening.
Hollow PEDs had a more favorable anatomical response than solid and drusenoid PEDs to anti-VEGF therapy. The best response occurred in large hollow PEDs (>1 DD in size) and the poorest response occurred in solid extrafoveal PEDs. Improvement in vision was unrelated to PED flattening.
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