De-novo Multilayering in Fibrovascular Pigment Epithelial Detachment

Abstract

This study describes the occurrence of multilayered pigment-epithelial detachment (MLPED) as a De-novo phenomenon (DN-MLPED) and compare the features with multi-layering secondary to chronic anti-vascular endothelial growth factor(anti-VEGF) therapy(s-MLPED). We did a retrospective evaluation of spectral-domain optical coherence tomography(SD-OCT) features, treatment-profile, and visual-acuity (VA) outcomes in eyes with MLPED. Out of 17 eyes with MLPED, 7 eyes had DN-MLPED and 10 eyes had s-MLPED. There was no significant difference in baseline and final VA between the groups. At the final visit, the DN-MLPED eyes showed improvement in VA (LogMAR-BCVA: Baseline=0.79±0.91; Final=0.76±0.73; p=0.87) while the s-MLPED eyes showed decline (LogMAR BCVA: Baseline=0.43±0.68; Final=0.94±0.71; p=0.87), although not significantly. Moreover, after presentation, the median number of injections in DN-MLPED eyes were significantly lower compared to s-MLPED eyes (DN-MLPED:4; s-MLPED:12; p=0.03) (Median follow-up: DN-MLPED=26months; s-MLPED=54months; p=0.15). Subretinal hyperreflective-material (SHRM) deposition heralded the onset of multilayering and was seen to progress in all DN-PED eyes and 1/4 eyes of s-MLPED. To conclude, MLPED is a unique form of cicatrizing fibrovascular-PED which can evolve denovo too. Long-standing disease with intermittent or low-grade activity can potentially explain this unique phenomenon. With fewer anti-VEGF therapy, the de-novo MLPED eyes show more visual stability as compared to s-MLPED eyes.