Abstract
Purpose: :
To describe the characteristics of serous retinal pigment epithelial detachments (PEDs) which appeared to be vascularized based on optical coherence tomography (OCT) imaging but subsequently failed to respond to anti-VEGF therapy and were determined, by their lack of response and stable clinical course, to be non-vascularized.
Methods: :
The retrospective study protocol was approved by the Institutional Review Board (IRB) of University of Miami. A retrospective chart review was performed on eyes with serous PEDs that had undergone intravitreal anti-VEGF therapy for the diagnosis of neovascular age-related macular degeneration from May 2005 through September 2008 and were subsequently found to be non-responsive to anti-VEGF therapy. The main outcome variables included best-corrected visual acuity (VA), number of intravitreal injections, changes in the shape and dimensions of PED, and presence of fluid in the macula as assessed by (OCT) and angiographic findings.
Results: :
Five eyes from 6 patients were identified as having serous PEDs unresponsive to anti-VEGF therapy. The follow up period after the last anti-VEGF therapy ranged from 2 to 23 months. Patients received between 3 and 7 monthly intravitreal injections. Initial visual acuity ranged from 20/30 to 20/80. None of the eyes lost vision. Four eyes had a visual acuity increase and two eyes remained stable. In all eyes, the subretinal fluid detected by OCT overlying the PED remained unchanged and no cystic retinopathy was detected at any time. The PEDs were persistent in all patients throughout the period of observation. None of the eyes had detectable choroidal neovascularization using fluorescein and indocyanine green angiography .
Conclusions: :
Serous PEDs with associated subretinal fluid, but with no evidence of intraretinal cysts by OCT or choroidal neovascularization by angiography, failed to respond to anti-VEGF therapy. These types of lesions can masquerade as vascularized PEDs due to the associated subretinal fluid seen on OCT imaging, but this fluid does not arise from underlying neovascularization.
Keywords: age-related macular degeneration • retinal pigment epithelium • vascular endothelial growth factor