Drusenoid Pigment Epithelial Detachment Characteristics Predict Subretinal Fluid

Drusenoid pigment epithelial detachment (PED) size, height, and volume can be used to establish the presence of subretinal fluid (SRF), according to research published in Retina. However, the SRF in drusenoid PED was not associated with visual prognosis or development of macular atrophy.

Researchers retrospectively analyzed the clinical characteristics of drusenoid PED in eyes without (n=33; mean age, 76.6±6.7 years; 39.4% men, 60.6% women) and with SRF (n=14; mean age, 72.7±6.2 years; 71.4% men, 28.6% women) and evaluated the impact of SRF on long-term visual and anatomical outcomes. All patients had at least 24 months of follow up (32.9±18.7 months). 

The study shows the patients with drusenoid pigment epithelial detachment with SRF had significantly higher PED height (468±130 vs 313±88 µm; P <.001), larger PED diameter (2328±953 vs 1227±882 µm; P <.001), and greater PED volume (1.88±1.73 vs 1.12±1.35 mm³; P =.021) than those with drusenoid pigment epithelial detachment without SRF at baseline. No significant difference was observed in best-corrected visual acuity between the groups at the final visit. 

The researchers report no significant differences in the incidence of complete retinal pigment epithelial (RPE) and outer retinal atrophy (cRORA; 21.4%) and the development of macular neovascularization (MNV; 7.1%) between the groups with drusenoid PED with SRF and without SRF (cRORA, 21.4% vs 39.4%; P =.61; MNV development, 7.1% vs 9.1%; P =.82 respectively). Additionally, the researchers explain that macular atrophy spontaneously resolved in approximately a quarter of these patients, and that anti-vascular endothelial growth factor injections may have no benefit to those with SRF in drusenoid pigment epithelial detachment.

“Our results showing how the PED size and volume are relevant to the presence of SRF supports the hypothesis that SRF accumulation leads to RPE dysfunction,” explain the study authors. “These results suggest that the SRF in drusenoid PED might differ from that of neovascular AMD in its development mechanism.” 

Limitations of the study included the retrospective design, relatively small sample size, lack of standardized visual acuity measurement, potential presences of undetected abnormal vessels, no quantitative analysis of serial changes in SRF.