Treatment of Retinal Pigment Epithelial Detachment

Abstract

Anatomical separation of the retinal pigment epithelium from the Bruch membrane is defi ned as retinal pigment epithelial detachment (PED) andit is classifi ed as drusenoid, serous, and vascularized. Vascularized PED is mostly associated with choroidal neovascularmembrane due to age-related macular degeneration and the risk of vision loss is high in this situation. Studies show that all of baseline values including BCVA, PED height, subretinal fl uid, central macular thickness, PED volume, vertical dimension, presence of coincident macular pathology, refl ectivity and morphology on optical coherence tomography have prognostic importance. Current treatment protocols mainly based on intravitreal injection of anti-vascular endothelial growth factor (VEGF). Even the bevacizumab was the fi rst anti-VEGF that was used for treatment in PED, there are several reports show the insuffi ciency of bevacizumab. In treatment-naïve eyes, both of ranibizumab and afl ibercepthave similar effect in vascularized PED. In treatment-resistant eyes, high dose bevacizumab or switching therapy of anti-VEGF procedures can be effective when considering of all cases, afl ibercept seems more effective than other options.We aimed in this manuscript, to give a general information about different characteristics of PEDs and to investigate the treatment strategies in the light of current literature.

When Eagle Stares into The Eye

“…[2] Serous PED is caused by fluid collection between RPE and BM due to increased choriocapillary leakage and decreased RPE pump function. The fundus lesion in serous PED is a well-demarcated, dome-shaped lesion, and the characteristic finding is best seen in OCT. [3] On OCT, they appear as a dome-shaped elevation of the RPE over a hyporeflective space, with Bruch's membrane being commonly visible as a straight, thin hyperreflective line at the base of the elevation. Treatment includes regular follow-up and monitoring for any complications like choroid neovascular membrane.…”

Intravitreal aflibercept in high retinal pigment epithelial detachments

“…ОПЭ сетчатки многими авторами расценивается как прогностически неблагоприятный для сохранения зрительных функций симптом [11,14], в связи с чем исследования эффективности ИВВ ингибиторов ангиогенеза при ОПЭ, ассоциированной с «влажной» ВМД, являются актуальными и социально значимыми.…”

“…Прорывом в лечении «влажной» формы ВМД явилось внедрение в клиническую практику интравитреального введения (ИВВ) ингибиторов фактора роста эндотелия сосудов (анти-VEGF-препаратов) [7][8][9][10]. Изучению эффективности ИВВ Ранибизумаба (Lucentis; «Genentech», США) для лечения влажной ВМД посвящено немало исследований, в том числе изучались исходы лечения серозных и неоваскулярных ОПЭ [11][12][13][14][15][16][17]. Однако результаты этих исследований противоречивы и не дают однозначных практических рекомендаций по назначению ингибиторов ангиогенеза при ОПЭ.…”