Abstract
To understand the natural history of retinal pigment epithelial (RPE) detachments (PEDs) associated with drusen, we retrospectively reviewed 125 PEDs that had not undergone laser treatment over an average follow-up period of 28 months. We identified six types of RPE detachments: pseudo-vitelliform, confluent drusen, serous, vascular, and hemorrhagic lesions as well as PEDs associated with a retinal vascular abnormality. We correlated the type of detachment with visual acuity and anatomic outcome. The poorest results were obtained for PEDs associated with neovascularization (vascular, hemorrhagic, and retinal vascular abnormality types). Eyes presenting with pseudo-vitelliform lesions or confluent drusen had the best visual prognosis and anatomic results. Obvious subretinal new vessels developed in 16 (34%) of the serous PEDs over an average follow-up period of 25 months. Subretinal neovascularization was rare in the pseudo-vitelliform and confluent drusen groups. The proposed classification system may be useful in predicting the natural course of PEDs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bellhorn RW, Burns MS, Benjamin JV (1980) Retinal vessel abnormalities of phototoxic retinopathy in rats. Invest Ophthalmol Vis Sci 19:584–595
Bird AC (1974) Recent advances in the treatment of senile disciform macular degeneration by photocoagulation. Br J Ophthalmol 58:367–376
Braunstein RA, Gass JDM (1979) Serous detachments of the retinal pigment epithelium in patients with senile macular disease. Am J Ophthalmol 88:652–660
Casswell AG, Kohen D, Bird AC (1985) Retinal pigment epithelial detachments in the elderly: classification and outcome. Br J Ophthalmol 69:397–403
Elman ML Fine SL, Murphy RP, Patz A, Auer C (1986) The natural history of serous retinal pigment epithelium detachment in patients with age-related macular degeneration. Ophthalmology 93:224–230
Gass JDM (1984) Serous retinal pigment epithelial detachment with a notch: a sign of occult choroidal neovascularization. Retina 4:205–220
Gass JDM (1987) Stereoscopic atlas of macular diseases; diagnosis and management, 3rd edn. Mosby, St. Louis, pp 60–91
Gass JDM, Jallow S, Davis B (1985) Adult vitelliform macular detachment occurring in patients with basal laminal drusen. Am J Ophthalmol 99:445–459
Ho PC, Namperumalsamy P, Pruett RC (1984) Photocoagulation of serous retinal pigment epithelium detachment in age-related detachments of the retinal pigment epithelium in patients with senile macular disease. Ann Ophthalmol 16:213–218
Klein BE, Klein R (1982) Cataracts and macular degeneration in older Americans. Arch Ophthalmol 100: 571–573
Krishan NR, Chandra SR, Stevens TS (1985) Diagnosis and pathogenesis of retinal pigment epithelial tears. Am J Ophthalmol 100:698–707
Leibowitz HM, Krueger DE, Maunder LR (1980) The Framingham Eye Study Monograph: an opthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration and visual acuity in a general population of 2631 adults. Surv Ophthalmol 24 [Suppl]:335–610
Macular Photocoagulation Study Group (1986) Argon laser photocoagulation for neovascular maculopathy: three-year results from randomized clinical trials. Arch Ophthalmol 104:694–701
Macular Photocoagulation Study Group (1987) Krypton laser photocoagulation for neovascular lesions of ocular histoplasmosis. Arch Ophthalmol 105:1499–1507
Meredith TA, Braley RE, Aaberg TM (1979) Natural history of serous detachments of the retinal pigment epithelium. Am J Ophthalmol 88:643–651
Moorfields Macular Study Group (1982) Retinal pigment epithelial detachments in the elderly: a controlled trial of argon laser photocoagulation. Br J Ophthalmol 66:1–116
Neter J, Wasserman W, Kutner MH (1985) Applied linear statistical models, 2nd edn. Irwin, Homewood, Illinois
Poliner LS, Olk RJ, Burgess D, Gordon ME (1986) Natural history of retinal pigment epithelial detachments in age-related macular degeneration. Ophthalmology 93:543–551
Sachs L (1984) Applied statistics, 2nd edn. Springer, New York Berlin Heidelberg, pp 474–493
20.SAS Institute Inc (1988) SAS/STAT user's guide, release 6.03. SAS Institute Inc., Cary, N.C., pp 549–640
Singerman LJ (1988) Laser photocoagulation for choroidal new vessel membrane complicating age-related macular degeneration associated with pigment epithelial detachment. Retina 8:115–121
Teeters VW, Bird AC (1973) The development of neovascularization of senile disciform macular degeneration. Am J Ophthalmol 76:1–18
Trempe CL, Mainster MA, Pomerantzeff O, Avila MP, Jalkh AE, Weiter JJ, McMeel JW, Schepens CL (1982) Macular photocoagulation: optimal wavelength selection. Ophthalmology 89:721–728
Weiter JJ, Jalkh AE, Smets E (1988) Classification of retinal pigment epithelial detachments in age-related macular degeneration. In: Gitter KA, Schatz H, Yarmuzzi LA, McDonald HR (eds) Laser photocoagulation of retinal disease. Pacific Medical Press, San Francisco, pp 193–200
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hartnett, M.E., Weiter, J.J., Garsd, A. et al. Classification of retinal pigment epithelial detachments associated with drusen. Graefe's Arch Clin Exp Ophthalmol 230, 11–19 (1992). https://doi.org/10.1007/BF00166756
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00166756