To determine the clinical course of untreated retinal pigment epithelial detachment we reviewed data from 50 eyes of 42 patients followed up for an average of 29 months without photocoagulation. In 14 eyes with avascular lesions, in patients under 50 years of age, all had a final vision of 20/30 or better. None developed neovascularisation or haemorrhage. In 17 eyes with avascular lesions in patients aged over 50, 8 (47%) flattened spontaneously. Five (24%) developed neovascularisation, 2 of which became haemorrhagic, with vision of less than 20/200. In 19 senile eyes with vascular lesions 14 (74%) had a final vision of 20/200 or less. The prognosis in eyes with pigment epithelial detachments is related to the age of the patient and the presence of choroidal neovascularisation. Photocoagulation is seldom needed for pigment epithelial detachments in young patients. Its value in senile eyes is unproved.
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