Aims To investigate the structure of multilayered pigment epithelial detachment (m-PED) in neovascular age-related macular degeneration, and its association with visual prognosis and the progression of fibrotic scars at 12 months.
Methods We retrospectively analysed 68 eyes of 63 patients with m-PED that included a prechoroidal cleft. The compartments within m-PED were divided into neovascular tissue (layer 1), a hyper-reflective band (layer 2), and a prechoroidal cleft (layer 3). Clinical variables were compared between patients manifesting layer 2 and those who did not. Multiple regression analyses were used to find the factors related to visual outcome and fibrotic scar formation.
Results Layer 2 was detected in 38 (55.9 %) of 68 eyes. With continuous treatment, the group with layer 2 showed gradual visual deterioration (p<0.001 at month 12), while the group without layer 2 showed visual improvement (p<0.001 at month 12). In the group with layer 2, the thickness of layer 2 significantly increased, and in the group without layer 2, if it formed, it increased gradually (p=0.004 at month 12). In both groups, other layers significantly decreased by month 12. The presence of layer 2 at baseline was significantly associated with a poor visual outcome (p=0.009) and fibrotic scar formation (p=0.023).
Conclusions The m-PED with layer 2 had a higher risk of fibrotic scar formation and was associated with a poor visual prognosis. Layer 2 may be an early stage precursor of a fibrotic scar.
- diagnostic tests/Investigation
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IK and GR are joint first authors.
Contributors MS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: IK, GR and MS. Data collection and statistical analysis: IK and GR. Drafting of the manuscript: IK and GR. Critical revision of the manuscript for important intellectual content: IK, GR and MS. Supervision: MS.
Funding MS was supported by the 2020 Yeungnam University research grant.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Institutional Review Board (IRB No.2020-09-085) and conformed to the Declaration of Helsinki. Only retrospective data were collected for analysis, and thus this study was exempt from informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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