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Differential diagnosis of avascular and vascularized retinal pigment epithelium detachments in age-related macular degeneration

M.A. Afanasyeva, A.A. Plyukhova, A.V. Shelankova

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Abstract

Purpose. Тo evaluate of differential diagnostic signs using optical coherence tomography in patients with avascular and vascularized serous retinal pigment epithelium detachment (RPE) in age-related macular degeneration (AMD). Material and methods. 40 people with AMD were examined. The patients were divided into two groups: avascular (20 patients) and vascularized (20 patients) serous RPE detachment. All patients underwent a standard ophthalmological examination and additional research methods: determination of the maximum corrected visual acuity using to the ETDRS (Early Treatment Diabetic Retinopathy Study) charts, OCT, OCT angiography. Results. Comparative analysis of OCT signs revealed that avascular serous RPE detachment is characterized by the presence of neuroepithelial detachment at the top of the RPE detachment (p = 0.002), neuroepithelial detachment is located within a triangle with the apex at the level of the inner limiting membrane of the retina, with a bisector drawn from the apex of the triangle through the point of maximum height RPE detachment and lateral sides that are tangent to the sides of the RPE detachment (p = 0.004). The presence of vascularized serous RPE detachment is characterized by intraretinal fluid (p = 0.002), prominence of the top of the RPE detachment (p = 0.009), thickness of the RPE at the top of the RPE detachment is greater than at the base (p = 0.006), hyperreflective layer under the RPE (p < 0.005), an increase in the hyperreflectivity of photoreceptors on the top of the RPE detachment relative to the base (p = 0.009). Conclusions. The identified differential diagnostic criteria make it possible to choose an adequate tactics for the treatment of patients with serous RPE detachment in age-related macular degeneration, depending on the identified form – vascularized or avascular. Keywords: retinal pigment epithelium detachment, age-related macular degeneration.

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Purpose. Тo evaluate of differential diagnostic signs using optical coherence tomography in patients with avascular and vascularized serous retinal pigment epithelium detachment (RPE) in age-related macular degeneration (AMD). Material and methods. 40 people with AMD were examined. The patients were divided into two groups: avascular (20 patients) and vascularized (20 patients) serous RPE detachment. All patients underwent a standard ophthalmological examination and additional research methods: determination of the maximum corrected visual acuity using to the ETDRS (Early Treatment Diabetic Retinopathy Study) charts, OCT, OCT angiography. Results. Comparative analysis of OCT signs revealed that avascular serous RPE detachment is characterized by the presence of neuroepithelial detachment at the top of the RPE detachment (p = 0.002), neuroepithelial detachment is located within a triangle with the apex at the level of the inner limiting membrane of the retina, with a bisector drawn from the apex of the triangle through the point of maximum height RPE detachment and lateral sides that are tangent to the sides of the RPE detachment (p = 0.004). The presence of vascularized serous RPE detachment is characterized by intraretinal fluid (p = 0.002), prominence of the top of the RPE detachment (p = 0.009), thickness of the RPE at the top of the RPE detachment is greater than at the base (p = 0.006), hyperreflective layer under the RPE (p < 0.005), an increase in the hyperreflectivity of photoreceptors on the top of the RPE detachment relative to the base (p = 0.009). Conclusions. The identified differential diagnostic criteria make it possible to choose an adequate tactics for the treatment of patients with serous RPE detachment in age-related macular degeneration, depending on the identified form – vascularized or avascular. Keywords: retinal pigment epithelium detachment, age-related macular degeneration.

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Available abstract

Purpose. Тo evaluate of differential diagnostic signs using optical coherence tomography in patients with avascular and vascularized serous retinal pigment epithelium detachment (RPE) in age-related macular degeneration (AMD). Material and methods. 40 people with AMD were examined. The patients were divided into two groups: avascular (20 patients) and vascularized (20 patients) serous RPE detachment. All patients underwent a standard ophthalmological examination and additional research methods: determination of the maximum corrected visual acuity using to the ETDRS (Early Treatment Diabetic Retinopathy Study) charts, OCT, OCT angiography. Results. Comparative analysis of OCT signs revealed that avascular serous RPE detachment is characterized by the presence of neuroepithelial detachment at the top of the RPE detachment (p = 0.002), neuroepithelial detachment is located within a triangle with the apex at the level of the inner limiting membrane of the retina, with a bisector drawn from the apex of the triangle through the point of maximum height RPE detachment and lateral sides that are tangent to the sides of the RPE detachment (p = 0.004). The presence of vascularized serous RPE detachment is characterized by intraretinal fluid (p = 0.002), prominence of the top of the RPE detachment (p = 0.009), thickness of the RPE at the top of the RPE detachment is greater than at the base (p = 0.006), hyperreflective layer under the RPE (p < 0.005), an increase in the hyperreflectivity of photoreceptors on the top of the RPE detachment relative to the base (p = 0.009). Conclusions. The identified differential diagnostic criteria make it possible to choose an adequate tactics for the treatment of patients with serous RPE detachment in age-related macular degeneration, depending on the identified form – vascularized or avascular. Keywords: retinal pigment epithelium detachment, age-related macular degeneration.

Key concepts: Retinal detachment, Ophthalmology, Medicine, Retinal pigment epithelium, Macular degeneration, Serous fluid, Retina, Retinopathy

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