Multilayered Pigment Epithelial Detachment in Neovascular Age-Related Macular Degeneration

Abstract

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.

Optical Coherence Tomography Angiography of Type 1 Neovascularization in Age-Related Macular Degeneration

“…21,22 Further, these patients were found to maintain good vision, possibly because of continued photoreceptor preservation. 9,21,22 In our study, the presence of atrophy was noted in 64% of eyes and was not found to have a statistically significant correlation with the morphologic pattern of the microvascular lesion.…”

“…The evidence of intraretinal, subretinal, and sub-RPE fluid (to determine whether the lesion was active or inactive); the presence of multilayered, highly organized material in the sub-RPE space; and the presence of RPE atrophy were also assessed on OCT imaging. 9 OCT angiography images were acquired using the RTVue XR Avanti with AngioVue (Optovue Inc, Fremont, California, USA), with an A-scan-rate of 70 000 scans per second, a light source of 840 nm, and a bandwidth of 45 nm. Macular cubes (3 3 3 mm) were acquired, each cube consisting of 304 clusters of 2 repeated B-scans containing 304 A-scans each.…”

Incidence and risk factors of massive subretinal hemorrhage in retinal angiomatous proliferation

“…This structure was termed “multilayered PED” by Rahimy and associates. [24] They assumed that this hyperreflective band develops within a chronic fibrovascular PED after repeated anti-VEGF suppression, and consisted of fibrocellular tissue. This fibrous tissue may exert contractile force on the fragile neovascular vessels, which could lead to rupture of these vessels, resulting in massive SRH.…”

Image Artifacts in Optical Coherence Tomography Angiography

“…In fibrovascular pigment epithelial detachments, particularly those that have been treated with anti-vascular endothelial growth factor, there are several layers. 15–17 The inner most is the RPE, under this are the neovascular vessels, and deeper there appears to be a layer of fibrotic tissue. If the en face OCTA image is taken through the vessels themselves, the RPE will be included and then by default the projection images from the retinal vessels will also be seen (Figure 8).…”