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MULTIMODAL IMAGING OF PIGMENT EPITHELIAL DETACHMENT: A Guide to Evaluation

Mrejen, Sarah MD*,†; sarraf, David MD‡,§; mukkamala, sri krishna MD*,†; freund, k. bailey MD*,†

Retina:
doi: 10.1097/IAE.0b013e3182993f66
Review
Abstract

Purpose: To describe the spectrum of pigment epithelial detachments (PEDs) occurring mainly in age-related macular degeneration and central serous chorioretinopathy and also in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders.

Methods: Pigment epithelial detachments are divided into drusenoid, serous, vascularized, or mixed categories.

Results: The clinical presentation, classification, and natural history of PEDs are reviewed as illustrated with multimodal imaging combining traditional and novel imaging techniques, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and spectral domain optical coherence tomography. Most PEDs occur because of pathophysiologic mechanisms taking place below the retinal pigment epithelium that are difficult to identify with conventional imaging modalities. Enhanced depth imaging optical coherence tomography and indocyanine green angiography allow a better analysis of the subretinal pigment epithelium compartment.

Conclusion: The differentiation between various kinds of PEDs is essential because each PED type is a distinct entity that has a specific pathogenesis, natural history, prognosis, and optimal treatment strategy.

In Brief

The purpose of this review were to describe the spectrum of pigment epithelial detachments occurring in age-related macular degeneration and other retinal disorders and to describe the clinical presentation, classification, and natural history of pigment epithelial detachments as illustrated with multimodal imaging combining traditional and novel imaging techniques.

Author Information

*Vitreous Retina Macula Consultants of New York, New York, New York;

LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York;

Retinal Disorders and Ophthalmic Genetics Division, Jules Stein, Eye Institute, University of California, Los Angeles, California; and

§Greater Los Angeles VA Healthcare Center, Los Angeles, California.

Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, Fifth Floor, New York, NY 10022; e-mail: kbfnyf@aol.com.

Supported in part by the Macula Foundation, Inc.

None of the authors have any conflicting interests to disclose.

© 2013 by Ophthalmic Communications Society, Inc.