Retinal pigment epithelial detachment

The vast majority of cases of AMD involve widespread disease with visible neovascularization, "occult" neovascularization, and serous as well as hemorrhagic detachments of the RPE. Accurate interpretation of the clinical and fluorescein angiographic findings in PEDs is difficult. The most noteworthy problem is the recognition of the presence and extent of associated neovascularization. Definitive guidelines for laser photocoagulation treatment of these PEDs have not yet been established. Large-scale, sophisticated clinical trials are needed to assess the efficacy and safety of laser treatment for this important manifestation of exudative AMD. Until these investigations are completed, certain cases of PEDs may be selected for laser treatment by one of three treatment techniques. A grid pattern photocoagulation to a serous PED may be carried out when there is no demonstrable or suspected underlying SRN and there is persistence and progression of the detachment with associated visual decline. Total photocoagulation of the PED which is suspected of having neovascularization can also be carried out if the fovea can be spared. Finally, photocoagulation of extrafoveal neovascularization beneath or at the margin of a PED can be performed in an attempt to obliterate the neovascularization, resolve the exudative manifestations, and stabilize or improve the vision. Only experienced retinal specialists who are well trained in the recognition of the complex clinical and fluorescein angiographic features of PEDs should attempt to treat these unusual and complicated cases.