Pigment epithelial detachment in the elderly. Clinical differentiation, natural course and pathogenetic implications

A prospective analysis was performed to characterize the angiographic appearance, natural course and prognosis of serous pigment epithelial detachments (PEDs) in elderly patients. The aim was to differentiate PEDs according to their angiographic characteristics and to analyze the specific clinical,...

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Bibliographic Details
Published in:Graefe's archive for clinical and experimental ophthalmology 2002-07, Vol.240 (7), p.533-538
Main Authors: Pauleikhoff, D, Löffert, D, Spital, G, Radermacher, M, Dohrmann, J, Lommatzsch, A, Bird, A C
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Diagnosis, Differential
Female
Fluorescein Angiography
Humans
Indocyanine Green
Longitudinal Studies
Male
Middle Aged
Ophthalmology
Pigment Epithelium of Eye - pathology
Prognosis
Prospective Studies
Retinal Detachment - diagnosis
Retinal Detachment - genetics
Retinal Detachment - physiopathology
Visual Acuity
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Summary:A prospective analysis was performed to characterize the angiographic appearance, natural course and prognosis of serous pigment epithelial detachments (PEDs) in elderly patients. The aim was to differentiate PEDs according to their angiographic characteristics and to analyze the specific clinical, visual and morphologic course of the different PEDs. Fluorescein and indocyanine green angiography were performed in 101 consecutive patients (53-87 years; 63 female, 38 male) with clinical signs of serous PED and drusen. Different types of serous PED were identified: polypoidal choroidal vasculopathy (PCV)-associated PED in 14 patients (13.9%), vascular PED in 72 (71.2%), and avascular PED in 15 (14.9%). All PEDs resulted initially in similar visual loss. Avascular PEDs were smaller than vascular PEDs, and the latter were smaller than PCV-PEDs. During follow-up these differences were always present, but all PEDs enlarged initially followed by regression. This course was associated in all PEDs with progressive visual loss, accompanied by the development of RPE atrophy in avascular PEDs or disciform scars or RPE tears in the two other types. Despite different associations, all PEDs have a similar clinical course with respect to visual loss and enlargement or regression. This is compatible with the proposed common pathogenetic background with a hydrophobic barrier in Bruch's membrane causing fluid resulting from RPE pumping activity to accumulate between the pigment epithelium and Bruch's membrane.
ISSN:0721-832X
1435-702X
DOI:10.1007/s00417-002-0505-8