Enhanced depth imaging optical coherence tomography of retinal pigment epithelial detachment in age-related macular degeneration.
OBJECTIVE
To describe the internal structure of pigment epithelial detachments (PEDs) seen in eyes with age-related macular degeneration (AMD) as imaged with enhanced depth imaging (EDI) spectral-domain optical coherence tomography (OCT).


METHODS
Retrospective observational case series.


METHODS
The images were obtained by positioning a spectral-domain OCT device close enough to the eye to obtain an inverted image and 7 sections, each comprised of 100 averaged scans, were obtained within a 5 degrees x 15 degrees or larger rectangle to encompass the PED and accompanying neovascularization if present. The resultant images were reinverted and compared with fluorescein and indocyanine green angiographic findings.


RESULTS
The full extent of the choroid was visualized under the PED in each of the 22 consecutive eyes imaged with EDI OCT. The entire PED cavity filled with hyperreflective tissue in 11 eyes. In the remaining 11 regions, what appeared to be serous fluid and collections of reflective material were found within the PED. The reflective material was seen to be contiguous with subretinal pigment epithelial neovascularization, had angiographic suggestive of fibrovascular proliferation, and was seen to course up along the back surface of the retinal pigment epithelium (RPE). Intravitreal ranibizumab injection caused PED flattening with apparent contracture of the accumulated material within the PED.


CONCLUSIONS
PEDs in the context of AMD show material suggestive of choroidal neovascularization, frequently on the back surface of the RPE. These findings can help explain the pathogenesis of PEDs, retinal vascular anastomosis with choroidal neovascularization, and RPE tears.
Spaide
Richard F
RF
Vitreous-Retina-Macula Consultants of New York and the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York 10022, USA. rickspaide@yahoo.com
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000175:diagnosis; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008268:Macular Degeneration / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000175:diagnosis*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence
D004396:Coloring Agents; D007208:Indocyanine Green