title: Multilayered pigment epithelial detachment in neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To describe the spectral domain optical coherence tomography findings in eyes with chronic fibrovascular pigment epithelial detachment (PED) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.
  
  
  METHODS
  Retrospective observational case series of patients with chronic fibrovascular PEDs receiving serial intravitreal anti-VEGF therapy. Corresponding spectral domain optical coherence tomography scans of chronic PEDs were studied in detail over multiple visits. The internal structure within the sub-PED compartment was analyzed, characteristic features were identified, and then correlated with visual outcome.
  
  
  RESULTS
  Thirty-eight eyes of 34 patients with fibrovascular PEDs were included. Mean and median Snellen visual acuity was 20/50 (range, 20/20-20/400). Eyes received a mean of 28.2 intravitreal anti-VEGF injections (median, 23.0; range, 3-70) administered over a mean of 36.9 months (median, 37.5; range, 6-84). A fusiform, or spindle-shaped, complex of highly organized layered hyperreflective bands was noted within each PED. Nineteen eyes demonstrated heterogenous, dilated, irregular neovascular tissue adherent to the undersurface of the retinal pigment epithelium. Additionally, 25 eyes demonstrated a hyporeflective cavity separating the choroidal neovascularization complex from the underlying choroid.
  
  
  CONCLUSIONS
  Chronic fibrovascular PEDs receiving serial anti-VEGF therapy demonstrate a characteristic fusiform complex of highly organized, layered, hyperreflective bands, termed a "multilayered PED," which is often seen in conjunction with neovascular tissue adherent to the undersurface of the retinal pigment epithelium monolayer. On the basis of previous histopathologic correlations, these bands may represent a fibrous tissue complex with contractile properties. An associated hyporeflective space, termed a "pre-choroidal cleft," separates the fusiform complex from the underlying choroid and may be due to contraction, the exudation of fluid, or both. Many of these eyes maintain good visual acuity, presumably because the neovascular and cicatricial process is suppressed within the sub-retinal pigment epithelium space by chronic anti-VEGF therapy, thus permitting the viability of the photoreceptor population through preservation of the retinal pigment epithelium.
authors.affiliation: *Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California; †Vitreous Retina Macula Consultants of New York, New York, New York; ‡Glostrup Hospital, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark; §Centro Brasileiro de Ciencias Visuais, Belo Horizonte, Brazil; and ¶Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Rahimy
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.forename: Richard F
authors.initials: RF
authors.lastname: Spaide
authors.forename: Rogerio A
authors.initials: RA
authors.lastname: Costa
authors.forename: Quan
authors.initials: Q
authors.lastname: Hoang
authors.forename: Christos
authors.initials: C
authors.lastname: Christakopoulos
authors.forename: Inger C
authors.initials: IC
authors.lastname: Munch
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A