Isolated pigment epithelium detachment: evidence for relation to central serous chorioretinopathy and effect of photodynamic therapy

Abstract

Purpose: To describe clinical characteristics and response to verteporfin therapy (PDT) in eyes with retinal pigment epithelium detachment (PED) in the absence of primary disease other than characteristics compatible with central serous chorioretinopathy (CSC). Methods: Retrospective review of 634 consecutive patients diagnosed with isolated PED or CSC in one or both eyes in the period from 2007 to 2014 at a single institution. Results: Pigment epithelium detachment (PED) in the absence of primary pathology other than angiographic choroidal hyperpermeability in the incident or fellow eye or manifest CSC in the fellow eye was found in 22 eyes in 19 patients. Follow-up ranged from 4 to 61 months. Five of 19 patients (26%) had classic CSC in the fellow eye. Transition from isolated PED to manifest CSC in the eye with PED was observed in seven eyes (33%) over a median untreated period of observation of 11 months (range, 1-32 months). A single session of PDT followed up 1-6 months later showed full resolution of the PED in seven (78%) of nine eyes. Of the 13 untreated eyes, five eyes (38%) underwent spontaneous resolution of the PED. Conclusion: Fellow-eye findings, conversion to CSC, resolution of PED after PDT or, less commonly, spontaneously support that isolated PED is a manifestation of CSC that represents an intermediate stage between pachychoroid and classic CSC. The chance of experiencing resolution of the PED was roughly twice as high with PDT as with untreated observation.

Outcomes of Retinal Pigment Epithelial Detachment in Vogt-Koyanagi-Harada Disease

“…This case suggests that idiopathic high hydrostatic pressure in the choroid, instead of the administration of systemic corticosteroids, might be the major cause of classic CSC development in this patient. According to this case, we can speculate that in other VKH patients who developed CSC after the application of systemic corticosteroid, the initial PED may result from a combination of two distinct mechanisms, VKH and intermediate stage between pachychoroid and classic CSC, as suggested by Arif et al [6], while the systemic corticosteroid administration may promote the choroidal enlargement, increase the hydrostatic pressure of PED and stretches for RPE, ultimately result in a defect of RPE monolayer and the development of classic CSC. This has been indirectly proved by the OCT images of the last follow-up in both case 5 and case 10, which demonstrated the complete remission of ERD and persist dilation of the outer large choroidal layer.…”

“…Pigment epithelial detachment (PED) is the anatomical separation between the basement membrane of the retinal pigment epithelium (RPE) and the inner collagenous layer of the Bruch membrane [5]. Isolated serous PED is frequently associated with choroidal hyperpermeability on ICGA and is regarded as an intermediate stage between pachychoroid and classic CSC [6]. Nonetheless, serous PED is an unusual nding in acute VKH characterized by choroidal thickening [7].…”

Efficacy of Half-Dose Photodynamic Therapy Versus High-Density Subthreshold Micropulse Laser for Treating Pigment Epithelial Detachments in Chronic Central Serous Chorioretinopathy

“…Importantly, half-dose PDT may also be an effective treatment in treating symptomatic isolated PEDs in the context of a pachychoroid background (e.g., pachychoroid pigment epitheliopathy) because it may target the common pathophysiological background of choroidal dysfunction and vascular leakage to the space between the RPE and Bruch membrane. 29,30 In conclusion, based on the results of this study, treatment with half-dose PDT, aimed at a complete resolution of SRF in patients with cCSC, is superior to HSML treatment with regard to reducing the height of macular PEDs. The outcome of this study may also have important implications for the treatment of PEDs in other diseases that are part of the pachychoroid spectrum.…”

Outcomes of retinal pigment epithelial detachment in Vogt-Koyanagi-Harada disease: a longitudinal analysis

“…The anatomical separation between the basement membrane of the retinal pigment epithelium (RPE) and the inner collagenous layer of the Bruch membrane is known as pigment epithelial detachment (PED) [ 5 ]. Isolated serous PED is frequently associated with choroidal hyperpermeability on ICGA and is regarded as a transitional stage between pachychoroid and classic central serous chorioretinopathy (CSC) [ 6 ]. Nonetheless, serous PED is an unusual finding in acute VKH characterized by choroidal thickening [ 7 ].…”