Serous Retinal Pigment Epithelial Detachment Research Articles

Spectral domain optical coherence tomography features of multiple subfoveal retinal pigment epithelial tears after intravitreal bevacizumab

Retinal pigment epithelial (RPE) tear has been described to occur spontaneously, after laser photocoagulation and in recent times, after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. In the latter case, the rapid contraction of the choroidal vascular membrane underneath a serous RPE detachment is believed to be the underlying cause. Preservation of good visual acuity after the occurrence of RPE tear with continued use of intravitreal VEGF agents has been reported. In this case report, we describe the occurrence of multiple RPE tears with the use of intravitreal bevacizumab and also correlate the preservation of visual acuity with features seen on spectral domain optical coherence tomography.

Giant retinal pigment epithelial tear after laser photocoagulation for diabetic retinopathy

A 62-year-old man, who underwent focal laser photocoagulation in the left eye (OS) for diabetic retinopathy 2 years previously, complained of metamorphopsia OS. The left fundus had a semilunar retinal...

Photodynamic therapy with verteporfin for age-related macular degeneration or polypoidal choroidal vasculopathy: comparison of the presence of serous retinal pigment epithelial detachment

Aim:To evaluate outcomes after photodynamic therapy (PDT) with verteporfin in Japanese patients with age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV) and compare results with the presence/absence of a...

Bilateral Multifocal Retinal Pigment Epithelium Detachments Associated with Systemic Corticosteroids

To report an unusual case of central serous chorioretinopathy (CSC), presenting as bilateral and multifocal isolated serous retinal pigment epithelium detachments (RPEDs) following corticosteroid treatment. An otherwise healthy 39-year-old man was evaluated for visual loss following blunt trauma of his right eye (RE). The patient underwent complete bilateral ophthalmologic examination, including optical coherence tomography and fluorescein (FA) and indocyanine green angiography (ICGA). At presentation, best-corrected visual acuity (BCVA) was 20/200 in the RE and 200/200 in the left eye (LE). Treatment included topical and oral corticosteroids. Three days later, the patient complained of metamorphopsia and further decrease in the VA of his RE. Fundus examination showed bilateral serous RPEDs. Optical coherence tomography, FA, and ICGA confirmed the diagnosis. Topical and oral corticosteroids were stopped and a follow-up examination 5 days later demonstrated marked resolution of the RPEDs in the RE. Five weeks later, RPEDs regressed in the RE while they persisted in the asymptomatic LE. Visual acuity in the RE further improved to 120/200. Nine months after the first visit, BCVA in the RE was 200/200. At that time, both eyes demonstrated retinal pigment epitheliopathy. Central serous chorioretinopathy is a known complication of corticosteroids. The classic variant of CSC consists of a shallow neuroretinal detachment located at the posterior pole of the fundus. Bilateral and multifocal isolated serous RPEDs represent an atypical form of CSC.

Successful treatment of a serous retinal pigment epithelial detachment by coiling of a carotid-cavernous fistula.

To report a patient presenting with a symptomatic retinal pigment epithelial detachment (RPED) that resolved after successful treatment of a slow flow dural carotid cavernous fistula (CCF). Possible pathophysiological mechanisms are discussed. Interventional case report. A 69-year-old female presented with left uniocular distortion, confirmed on fluorescein and indocyanine green angiography to be secondary to a non-vascularised serous RPED. Further examination revealed a long standing left VI nerve palsy, mild proptosis and conjunctival injection. Magnetic resonance and cranial angiography confirmed the presence of a dural CCF. Surgical closure of the CCF resulted in a rapid resolution of the clinical signs and improvement in visual symptoms. Patients with serous RPED and other signs or symptoms of a CCF may warrant neuroimaging of the orbit and/or angiography to evaluate for CCF, as correct diagnosis may lead to an excellent visual outcome.

Clinical relevance of the new digital integration method for the precise correlation of fluorescein angiographic and optical coherence tomography findings

A fundamental weak point in the previous optical coherence tomography (OCT) pictures of Stratus OCT III is counterbalanced through the correction of eye movement artefacts by the new digital integration method (DIM). For the first time, DIM allows the precise anatomical OCT-scan localization in the fundus or fluorescein angiographic (FLA) image and leads to an objective morphological and topographic correlation. Using a newly developed fundus enhancement system (FES), DIM provides fundus images of OCT of high quality in almost every patient. To control and document any possible eye movement artefacts, a retinal tracking system was developed (RTS). The RTS tapes the fundus image in OCT during the scanning procedure. Using the new morphological information a new knowledge is obtained on uncertain angiographic phenomena by detecting serous retinal pigment epithelium (RPE) detachments and may lead to treatment consequences. In FLA images without leakages DIM reveals in OCT undetected serous RPE detachments. In addition, in 100% classic choroidal neovascularization (CNV) with a hypofluorescent halo DIM demonstrates a larger extent of the CNV than expected in FLA. Using DIM the OCT-scan position for the follow-up can be now assessed in a safe and reliable manner, which is mandatory for the evidence of OCT studies.

RETINAL PIGMENT EPITHELIUM TEARS AFTER INTRAVITREAL INJECTION OF BEVACIZUMAB (AVASTIN) FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab. In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate. Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%. RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.

BILATERAL MIDPERIPHERAL LARGE DRUSEN AND RETINAL PIGMENT EPITHELIAL DETACHMENTS ASSOCIATED WITH MULTIFOCAL AREAS OF CHOROIDAL NEOVASCULARIZATION

The ocular histopathologic features of a patient with bilateral multiple midperipheral areas of choroidal vascularization, large drusen, and detachments of the retinal pigment epithelium (RPE) are presented. The eyes were obtained at autopsy and fixed in 4% buffered formaldehyde. Serial sections through the macula area and inferior segments were prepared. Light as well as electron microscopy was performed. Microscopic examination disclosed numerous large drusen measuring up to 200 micro m in height and 280 micro m in diameter and areas of serous RPE detachments in the midperiphery of both eyes. Some of the large drusen had choroidal vascularization. Areas of sub-RPE neovascularization that measured up to 6.5 mm in diameter were present in the midperiphery of both eyes. The choroidal origin for neovascularization was evident in 10 areas. A 1-mm area of hemorrhagic detachment of the RPE contiguous with choroidal neovascularization (CNV) was present in the immediate postequatorial area temporally in the left eye. No drusen, basal deposit, or CNV was present in the macular area. Multifocal midperipheral RPE detachments and CNV can occur in the absence of significant age-related macular disease.

Fotocoagulación láser en la vasculopatía coroidal polipoidea idiopática: Seguimiento superior a un año

Long term assessment of the evolution of Idiopathic Polypoidal Choroidal Vasculopathy (IPCV) in symptomatic patients treated by laser photocoagulation. We carried out a retrospective study involving seven eyes in six patients with visual impairment, affected by IPCV, confirmed by indocyanine green angiography. All were treated by laser photocoagulation and monitored during a period of at least one year. The controls were evaluated during the first, third, sixth and twelfth month, in order to assess whether it was necessary to repeat the treatment. Of the six patients with IPCV lesions, two were men and four were women (1:2) aged between 58 and 81 years (mean = 73 years), and monitored for a time interval of 18 and 75 months (mean = 39 months). The average initial visual acuity was 0.25, and the final was 0.15. All the patients had the other eye also affected: three had a macular disciform scar, secondary to the previous haemorrhagic episodes, two had asymptomatic polyps and in one patient we defined active bilateral IPCV which was treated by laser photocoagulation. In two eyes it appeared as a macular haemorrhage, in four eyes as a serosanguinous retinal pigment epithelial (RPE) detachment and in one eye as a serous RPE detachment. Three eyes suffered a relapse which required further laser photocoagulation treatment. Laser photocoagulation is a palliative treatment for IPCV. Final vision achieved is poor and relapse is frequent. Other procedures should be used to treat this disease.

BILATERAL IDIOPATHIC MULTIFOCAL RETINAL PIGMENT EPITHELIUM DETACHMENTS IN OTHERWISE HEALTHY MIDDLE-AGED ADULTS

To present the results of a clinicopathologic study of patients with bilateral idiopathic multifocal serous retinal pigment epithelial detachments (RPEDs). Retrospective review of the medical records of three middle-aged patients with innumerable RPEDs. The eye of one patient was available for histopathologic examination. The presence of multiple serous RPEDs was verified with fluorescein angiography and optical coherence tomography in two patients and by histopathologic examination of one eye of a third patient, who developed a submacular hematoma and vitreous hemorrhage caused by a focal area of choroidal neovascularization. No cause for the multifocal serous RPEDs was found.

Photodynamic therapy for chronic serous detachment of the retinal pigment epithelium in a young patient

Recently, photodynamic therapy (PDT) has proven beneficial in the treatment of chronic central serous chorioretinopathy (CSCR). As with CSCR, chronic serous retinal pigment epithelial detachment (RPED) can also lead to a significant decrease in visual acuity. We describe a case of chronic serous RPED in a young patient that progressively worsened over several years but regressed markedly, with improvement in visual acuity, after PDT with verteporfin.

Abnormalities of fundus autofluorescence in central serous retinopathy

PURPOSE: To report abnormalities of fundus autofluorescence associated with acute and chronic central serous retinopathy (CSR). DESIGN: A prospective cohort study of patients with CSR was undertaken in which the intensity and spatial distribution of fundus autofluorescence were documented. METHODS: Fundus autofluorescence was recorded using a confocal laser scanning ophthalmoscope (cLSO) and the images compared with the fundus appearance and fluorescein angiograms in 69 eyes of 63 subjects with either acute or chronic CSR. Areas of increased and decreased autofluorescence were compared with ophthalmoscopic and fluorescein angiography abnormalities. Thirty patients with focal leakage on angiography and serous retinal detachment or pigment epithelial detachment were designated as having acute CSR. Thirty-three patients with diffuse leakage on fluorescein angiography, but without manifest detachment were classified as having chronic CSR. RESULTS: The mean age was 39 years (range 29–56 years) 14 were female and 49 male. Acute CSR of more than 4 months duration showed a mild diffuse increase in autofluorescence that corresponded with the detached area. The leaking point on the angiogram corresponded to a focal area of intense autofluorescence. In chronic CSR the autofluorescence was very irregular, there being regions with greater and less than the background levels of fluorescence. CONCLUSION: In acute CSR, increased autofluorescence may occur at the site of leakage and in the area of retinal detachment probably indicating an increased metabolic activity of the retinal pigment epithelium (RPE). Decreased or absent autofluorescence in long-standing lesions may indicate reduced metabolic activity of the RPE due to photoreceptor cell loss. Documenting photoreceptor cell loss with autofluorescence imaging may be useful in identifying patients who would not benefit from laser photocoagulation.

Retinopathy of Great Pyrenees dogs: fluorescein angiography, light microscopy and transmitting and scanning electron microscopy

Investigation of the pathogenesis of Great Pyrenees retinopathy. One male and two female puppies of parents who were affected with Great Pyrenees retinopathy and one 4-year-old affected adult male Great Pyrenees dog. The puppies were examined daily from 7 weeks of age by indirect ophthalmoscopy and their fundi were photographed until the lesions were static. Fluorescein angiography was completed at 7 weeks of age, within 24 h of detection of ophthalmoscopic lesions, and then weekly. The eyes of a 4-year-old and two 20-week-old puppies were examined with light microscopy, and transmitting and scanning electron microscopy. Blocked choroidal fluorescence was detected at 7 weeks of age. The blocked fluorescence enlarged, when the characteristic serous retinal detachments developed at 11 weeks of age. The detachments enlarged in size and number until the puppies were approximately 20 weeks old. Fluorescein pooling confirmed the presence of transient retinal pigment epithelial detachments. Leakage of dye into serous retinal detachments was not detected in this study. Light microscopy and transmitting and scanning electron microscopy confirmed the presence of multifocal serous retinal detachments with focal retinal degeneration that extended to the inner nuclear layer in a 4-year-old dog. The retinal detachments were accompanied by hypertrophy, hyperplasia, increased pigmentation, and vacuolation of the retinal pigment epithelium. Great Pyrenees retinopathy is manifested by multifocal serous retinal and retinal pigment epithelial detachments. These detachments are similar to those noted with central serous retinopathy of humans. The sudden development of multifocal retinal and retinal pigment epithelial detachments, and the serous nature of these detachments, supports a theory that they develop secondary to focal secretion and absorption defects in retinal pigment epithelial cells. Given the age of the puppies when the blocked choroidal fluorescence was noted and maturation of the dog retina at 8 weeks postpartum, this retinopathy is considered to be a retinal pigment epithelial dysplasia. This unique inherited retinopathy offers an opportunity to study retinal pigment epithelial secretion.

Hyperfluorescence associated with serous retinal pigment epithelial detachment on indocyanine green angiography.

Indocyanine green angiography has been reported to improve detection and delineation of occult choroidal neovascularisation in serous pigment epithelium detachment in age-related macular degeneration. The study aims to evaluate the visual acuity results of eyes affected by serous pigment epithelium detachment in age-related macular degeneration, having had indocyanine green-directed laser photocoagulation, and to correlate them to the pattern of serous pigment epithelium detachment on indocyanine green angiography. Thirty-four eyes of 31 patients affected by serous pigment epithelium detachment in age-related macular degeneration were prospectively considered. Each patient underwent an ophthalmological examination including fluorescein and indocyanine green angiography one day before, and 6 weeks, 3 months, 6 months, 9 months, 12 months and 24 months after krypton-laser treatment. The serous pigment epithelium detachment was classified in the late-phases angiograms as either hypofluorescent, isofluorescent or hyperfluorescent comparing the fluorescence of the serous pigment epithelium detachment with the choroidal background fluorescence. The indocyanine green-guided laser treatment was associated with a temporary stabilization and a long-term progressive reduction of visual acuity: after 24 months visual acuity improved in 2.9%, stabilized in 26.5% and worsened in 70.5% of cases. Serous pigment epithelium detachment presenting a pretreatment hyperfluorescence had a final visual acuity of 0.06, with subfoveal choroidal neovascularisation development in 100% of cases, whereas serous pigment epithelium detachment presenting a pretreatment hypofluorescence and isofluorescence showed a final visual acuity of 0.12, with subfoveal choroidal neovascularisation development in 43.5% of eyes, with statistically significant difference. Overall visual acuity decreases with time after indocyanine green-guided laser treatment of choroidal neovascularisation in serous pigment epithelium detachment, and serous pigment epithelium detachment becoming hyperfluorescent in the late-phases of indocyanine green angiography has the worst functional outcome.

Optical coherence tomography of orange-red subretinal lesions in eyes with idiopathic polypoidal choroidal vasculopathy

PURPOSE: %To study the cross-section images of orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy and compare their protrusions quantitatively with those of serous retinal pigment epithelium detachment. METHODS: Optical coherent tomography images scanning remarkable orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy and serous retinal pigment epithelium detachment in age-related macular degeneration or central serous chorioretinopathy were prospectively recorded. The correlation between the base diameter and the height of the lesions was analyzed. RESULTS: Optical coherence tomography images show prominent anterior protrusion of the orange-red lesions. The ratio of the height to the base diameter of the orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy is 0.32 ± 0.05, and it is significantly larger than lesions in eyes with serous retinal pigment epithelium detachment (0.18 ± 0.05, P < .001). CONCLUSION: The orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy have a more sharply peaked shape than serous retinal pigment epithelium detachment as a subretinal structure, suggesting polypoidal vascular lesions in eyes with idiopathic polypoidal choroidal vasculopathy are situated beneath the Bruch membrane and covered anteriorly with both the retinal pigment epithelium and the Bruch membrane.

Indocyanine Green Hyperfluorescence Associated with Serous Retinal Pigment Epithelial Detachment in Age-related Macular Degeneration

Indocyanine green (ICG) angiography may improve visualization of choroidal neovascularization (CNV) associated with serous retinal pigment epithelial detachment (RPED) in age-related macular degeneration (AMD). The features of ICG hyperfluorescence associated with serous RPED and therapeutic effect of ICG-directed laser photocoagulation in eyes with serous RPED is evaluated. Retrospective review of all simultaneous fluorescein/ICG angiograms (n = 918) performed over an 18-month period to identify 44 eyes in 39 patients with serous RPED secondary to AMD on fluorescein angiography. Thirty-nine patients with AMD, aged 53 to 89 years, participated. Eyes were nonrandomly treated with ICG-directed laser photocoagulation or observation. Characteristics of ICG hyperfluorescence associated with a serous RPED are reviewed. Final visual acuity and anatomic appearance of the serous RPED are given. Twenty-three (52%) of the 44 eyes had an isolated serous RPED without obvious CNV, and 21 (48%) of the 44 eyes had a serous RPED associated with occult CNV on fluorescein angiography. Indocyanine green angiography demonstrated underlying CNV in 19 eyes (83%) with an isolated serous RPED and in all 21 eyes (100%) with serous RPED and occult CNV. The pattern of ICG hyperfluorescence revealed focal CNV in 15 eyes and plaque CNV in 4 eyes with an isolated serous RPED. In eyes with serous RPED and occult CNV, focal CNV and plaque CNV were noted with ICG in 8 and 13 eyes, respectively. No follow-up was available for two eyes. Twenty eyes were treated with ICG-directed laser photocoagulation. In these eyes, the visual acuity remained stable in 6 eyes (30%) and decreased in 14 eyes (70%). Twenty-two eyes were observed, and the visual acuity remained stable in 8 (36%), improved in 2 (9%), and decreased in 12 eyes (55%). Although ICG angiography may enhance visualization of CNV associated with serous RPED in AMD, ICG-directed laser treatment did not appear to improve visual acuity when compared with observed eyes in this series.

Digital Indocyanine Green Videoangiography of Central Serous Chorioretinopathy

Background: The pathogenesis of central serous chorioretinopathy (CSC) is poorly understood. Abnormalities in the choroidal circulation have been hypothesized to be causative factors. Fluorescein angiography has not been particularly useful in identifying specific choroidal defects in CSC, largely because of inherent limitations in imaging with this technique. Recent technologic advances in digital indocyanine green videoangiography allow enhanced imaging of the choroid and other subretinal structures in comparison with fluorescein angiography. Methods: We performed digital indocyanine green videoangiography in 29 consecutive eyes with CSC and compared our results with clinical and fluorescein angiographic findings. Results: Several newly recognized subretinal abnormalities in CSC were noted with digital indocyanine green videoangiography, including (1) presumed hyperpermeability of the choroidal circulation surrounding active retinal pigment epithelial leaks, (2) additional focal and multifocal areas of presumed choroidal hyperpermeability not associated with abnormalities detectable by fluorescein angiography or clinical examination, and (3) multiple presumed occult serous retinal pigment epithelial detachments with a characteristic indocyanine green videoangiographic pattern. Conclusion: We suggest that the pathogenesis of CSC may be due to a choroidal vascular hyperpermeability with and without associated active pigment epithelial leaks and multiple presumed occult serous retinal pigment epithelial detachments. Based on these findings, a hypothetical model can be constructed related to the pathogenesis of CSC, beginning with choroidal abnormalities that secondarily affect the retinal pigment epithelium and neurosensory retina.

Investigation and prognosis in the retinal pigment epitheliopathies.

Eighty-three patients with retinal pigment epitheliopathy have been identified from the photographic and fluorescein records of the Tennent Institute of Ophthalmology in Glasgow. Many have been brought back for follow-up assessment. Twenty-seven patients had placoid lesions, 22 geographic lesions and 15 a condition which we propose to rename the 'not ocular histoplasmosis' (NOH) syndrome. Patients with placoid lesions could be divided into typical acute multifocal placoid pigment epitheliopathy (AMPPE), where the long-term visual prognosis was poor because of recurrent disease leading to extensive areas of atrophy, and acute diffuse placoid pigment epitheliopathy which seemed to be self-limiting. No consistent evidence of viral or immunological abnormality was found in either group of patients. Geographic lesions appeared to result either from a coalescence of focal lesions or from a slow (serpiginous) spread from a single focus. Four patients with helicoid atrophy lost central vision from disciform lesions. Seven patients had pigment epithelial disorder associated with sarcoidosis. The pigment epithelial disease was unresponsive to systemic corticosteroid therapy and tended to be complicated by disciform lesions. Disciform lesions may occur in any type of pigment epitheliopathy, as may serous retinal detachment or pigment epithelial detachment. A technique for the biopsy of choroid and retinal pigment epithelium is described. This may lead to a better understanding of these disorders.

The Natural History of Serous Retinal Pigment Epithelium Detachment in Patients with Age-related Macular Degeneration

One hundred ten patients with serous detachment of the retinal pigment epithelium (RPE) were reexamined to enhance our knowledge of the natural course of this condition. All patients were greater than 50 years of age, had age-related macular degeneration, and had neither blood, lipid; nor angiographic evidence of a definite choroidal neovascular membrane (NVM) at the time of the initial examination. All patients were followed up for at least six months except for two patients who had developed a choroidal NVM within the first six months of the initial exam. Forty-five of 140 eyes (32%) developed a choroidal NVM within an average of 19.6 months (median, 12 months). This was associated with a final visual acuity of 20/200 or worse (P < 0.0001). Ophthalmoscopic and angiographic features present at the initial visit which were associated with the development of NVM and poor final visual acuity were: (1) sensory retinal detachment; (2) increased size of PED; (3) hot spot; (4) late filling; (5) notching; and (6) irregular filling. At the most recent examination, 39% of the eyes had a final visual acuity of 20/20 to 20/40; while 24% of the eyes had a final visual acuity of less than or equal to 20/200.

Pathologic Features of Senile Macular Degeneratlon

Senile macular degeneration (SMD) has several morphologic forms that may exist singly or in various combinations. Patients with drusen are at an increased risk to develop SMD. Types of drusen that have been recognized clinically and histopathologically include hard or nodular, soft, glistening or calcified, and diffuse. Hard drusen are probably a consequence of extrusion of material from one or a cluster of retinal pigment epithelial (RPE) cells. Soft drusen are a sign of more widespread disease of the RPE, develop in eyes with hard drusen, and represent small areas of serous detachment of the RPE and the thickened inner aspect of Bruch's membrane. RPE areolar atrophy can occur in the setting of hard and soft drusen and in larger RPE detachments. From the morphologic point of view, we propose that the process leading to disciform scar formation in SMD begins with thickening of the inner aspect of Bruch's membrane due to production of abnormal basement membrane by the RPE. This thickened area is weakly attached and allows the development of localized detachments (soft drusen). These localized detachments become confluent into large detachments of the RPE. Choroidal neovascularization occurs in association with diffuse and soft drusen and larger serous RPE detachments. Bleeding from neovascular tissue leads to disciform scar formation.