[Pigment epithelial detachments in age-related macular degeneration -- classification, differentiation and prognosis].
BACKGROUND
A pigment epithelial detachment (PED) is an exudative manifestation of late age-related macular degeneration (AMD). Its long-term unfavourable prognosis is influenced by the association of a neovascular membrane. Seemingly identical PEDs in ophthalmoscopy can be further differentiated by fluorescein and indocyanine green angiography. The purpose of this prospective follow-up study was to determine the most reliable angiographic classification to distinguish PEDs in AMD and to evaluate their outcome.


METHODS
73 eyes of 68 patients with a PED in AMD were examined with simultaneous angiography with fluorescein and indocyanine green. 34 eyes were additionally scanned by retinatomography. Fluorescein angiographic classification comprises 4 types: 1. early hyperfluorescent type, 2. late hyperfluorescent type, 3. drusen type, 4. irregular fluorescent type. Indocyanine green angiographic classification consists of the following three groups: 1. angiographically no vascularisation, 2. associated choroidal neovascularisation, 3. associated polypoidal choroidal vasculopathy.


RESULTS
Both classifications show statistically significant correlation with visual acuity (fluorescein classification: P = 0.0112, ICG-classification: P = 0.0004) and area of the PEDs (fluorescein classification: P = 0.0002, ICG-classification: P < 0.0001). ICG-classification additionally is significantly associated with the volume (P = 0.0008). Both classifications correlate (P = 0.0001). Factors influencing visual acuity are: age (P = 0.0044), associated neovascular membrane (P = 0.0004), area (P < 0.0001), volume (P = 0.0077) and height (P < 0.0001).


CONCLUSIONS
PEDs in AMD can best be classified by indocyanine green angiography on the basis of an associated prognostically important neovascular membrane, which can only be further distinguished into choroidal neovascularisation or polypoidal choroidal vasculopathy by indocyanine green angiography. Statistical analysis shows qualitatively and quantitatively more significant results for the indocyanine green angiographic classification.
Brumm
Gabriele
G
Augenabteilung St. Franziskus Hospital Münster.
Spital
Georg
G
Radermacher
Martin
M
Lommatzsch
Albrecht
A
Pauleikhoff
Daniel
D
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000145:classification / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011379:Prognosis; D012163:Retinal Detachment / Q000145:classification / Q000175:diagnosis*; D015861:Retinal Neovascularization / Q000145:classification / Q000175:diagnosis