Two-Year Course of Subfoveal Pigment Epithelial Detachment in Eyes with Age-Related Macular Degeneration and Visual Acuity Better than 20/40

Abstract

Purpose: To investigate the course of subfoveal pigment epithelial detachments (PEDs) in eyes with age-related macular degeneration (AMD) and best-corrected visual acuity (BCVA) ≥20/40. Methods: Thirty-seven eyes of 35 patients with a subfoveal PED were divided into an avascular PED group (n = 11), a vascularized PED group due to polypoidal choroidal vasculopathy (PCV, n = 14) and an occult choroidal neovascularization (CNV) group (n = 12). Intravitreal bevacizumab or ranibizumab was given as needed. The BCVA, central foveal thickness, PED thickness, and lesion size were measured at baseline and at 2 years after the initial examination. Results: The BCVA did not change significantly in the avascular group, decreased from 0.06 ± 0.11 to 0.23 ± 0.15 logMAR units in the PCV group and from 0.12 ± 0.12 to 0.71 ± 0.70 logMAR units in the CNV group. At 2 years, the central foveal and PED thicknesses were not significantly different among the 3 groups, and the lesion was significantly larger in the PCV and CNV groups than in the avascular group. Conclusions: The vascularized PED cases had a poorer visual outcome than avascular PEDs with anti-VEGF drugs at the 2-year follow-up.

Factors Influencing the Treatment Response of Pigment Epithelium Detachment in Age-Related Macular Degeneration

“…This is often associated with poor functional long-term outcomes. [29][30][31] It is unknown whether anti-VEGFinduced PED flattening improves the functional outcome. In analogy with the aim of a dry macula, one may be tempted to assume that PED flattening favors functionality.…”

Earlier therapeutic effects associated with high dose (2.0 mg) Ranibizumab for treatment of vascularized pigment epithelial detachments in age-related macular degeneration

“…At 12 months after treatment, there was marked worsening of vision for eyes treated with PDT or PDT and IVT, and mild decreased vision for eyes treated with anti-VEGF injections despite favorable anatomic outcomes. Baba et al 14 reported that of 37 eyes receiving anti-VEGF therapy, there were no changes in visual outcome in eyes with avascular PED but decreased vision in eyes with vPED or PCV despite similar improvement in PED heights at 2 years. On the other hand, Inoue et al 15 reported visual stabilization despite no anatomical correlation after treatment of 56 eyes with PED due to AMD at 12 months.…”

“…Recent studies have shown variable outcomes associated with anti-VEGF therapy for this condition. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] In 2012, Introini et al 13 studied 132 eyes with vPED or retinal angiomatous proliferation lesions treated with PDT, PDT and intravitreal corticosteroid (IVT),or anti-VEGF therapy over 10 years. At 12 months after treatment, there was marked worsening of vision for eyes treated with PDT or PDT and IVT, and mild decreased vision for eyes treated with anti-VEGF injections despite favorable anatomic outcomes.…”

“…Recent studies evaluated the outcomes of ranibizumab for treating vPED due to AMD, but not comparing the results of various doses of ranibizumab. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] Our prospective study addressed the benefits and risks of 2.0 vs 0.5 mg ranibizumab for treating vPED due to AMD on a monthly as well as pro-re nata (PRN) basis for up to 12 months.…”

The Effect of Intravitreal Anti-VEGF on the Pigment Epithelial Detachment in Eyes with the Exudative Type of Age-Related Macular Degeneration

“…24 Furthermore, Baba et al reported that the PED thicknesses were not significantly different after two years of anti-VEGF therapy among three groups with vascularized PED due to CNV, avascular PED and vascularized PED due to polypoidal choroidal vasculopathy (PCV). 25 Comparisons between the PED group and the control group revealed no significant difference in BCVA between the two groups. On the contrary, it was found that the PED group needed a mean of 2.1 more intravitreal injections than the control group in order to reach the same BCVA.…”