[Idiopathic serous retinal pigment epithelial detachment (a case report)].
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Abstract:
Retinal pigmented epithelium detachment is frequently associated to age related macular degeneration or others maculopathies. More rarely no cause can be found, particularly in young patients where it constitutes an entity named "Idiopathic serous detachment of the retinal pigmentary epithelium". We report such a case. We insist on the clinical and angiographical characteristics which allows a differentiation from the idiopathic central serous chorioretinopathy with which it can be confused. Last, it is important to point that for the time being no treatment can shorten the evolution.Keywords:
Degeneration (medical)
Macula Lutea
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Purpose. Тo evaluate of differential diagnostic signs using optical coherence tomography in patients with avascular and vascularized serous retinal pigment epithelium detachment (RPE) in age-related macular degeneration (AMD). Material and methods. 40 people with AMD were examined. The patients were divided into two groups: avascular (20 patients) and vascularized (20 patients) serous RPE detachment. All patients underwent a standard ophthalmological examination and additional research methods: determination of the maximum corrected visual acuity using to the ETDRS (Early Treatment Diabetic Retinopathy Study) charts, OCT, OCT angiography. Results. Comparative analysis of OCT signs revealed that avascular serous RPE detachment is characterized by the presence of neuroepithelial detachment at the top of the RPE detachment (p = 0.002), neuroepithelial detachment is located within a triangle with the apex at the level of the inner limiting membrane of the retina, with a bisector drawn from the apex of the triangle through the point of maximum height RPE detachment and lateral sides that are tangent to the sides of the RPE detachment (p = 0.004). The presence of vascularized serous RPE detachment is characterized by intraretinal fluid (p = 0.002), prominence of the top of the RPE detachment (p = 0.009), thickness of the RPE at the top of the RPE detachment is greater than at the base (p = 0.006), hyperreflective layer under the RPE (p < 0.005), an increase in the hyperreflectivity of photoreceptors on the top of the RPE detachment relative to the base (p = 0.009). Conclusions. The identified differential diagnostic criteria make it possible to choose an adequate tactics for the treatment of patients with serous RPE detachment in age-related macular degeneration, depending on the identified form – vascularized or avascular. Keywords: retinal pigment epithelium detachment, age-related macular degeneration.
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To study the visual and angiographic outcome of eyes with neovascular age-related macular degeneration associated with pigment epithelium detachment (PED) treated by photodynamic therapy.Review of the medical charts and the fluorescein and indocyanine green angiograms of all consecutive patients with age-related macular degeneration associated with choroidal neovascularization and serous PED of at least 1 disc diameter, who received photodynamic therapy from January 1, 2000, to August 31, 2002.Thirty patients (34 eyes) met the study criteria. Each underwent 1 to 8 treatments (mean, 4); duration of follow-up was 12 to 36 months (mean, 19 months). Nineteen eyes (56%) lost 3 or more Snellen lines of visual acuity, 7 eyes (21%) lost 1 or 2 lines, 6 eyes (18%) maintained their initial acuity, and 2 eyes (6%) gained 1 or 2 lines. Subretinal hemorrhage occurred in 5 eyes and retinal pigment epithelium tears in 4 eyes. In 4 eyes, visual acuity decreased to counting fingers, hand motions, or light perception.Although 44% of the 34 eyes with age-related macular degeneration and PED lost fewer than 3 Snellen lines in acuity, severe visual loss to counting fingers or less occurred in 4 eyes, 3 of them with choroidal neovascularization inside the PED. Further studies and treatment modalities are required to improve prognosis of neovascular age-related macular degeneration with serous PED.
Verteporfin
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This is a case report of a 47-year-old male patient , a diabetic who presented with gradual loss of vision in both eyes. He had a combination of central serous retinopathy with diabetic retinopathy. Retinal laser was not possible due to exudative retinal detachment posing a therapeutic dilemma.
Retinal Disorder
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Forty-one patients with Wagner's vitreoretinal degeneration were studied. The polymorphous ocular signs of this disease included vitreous changes, myopia, cataract, retinal pigmentation, retinal breaks, patchy areas of thinned pigment epithelium or of chorioretinal atrophy, narrowing or sheathing of the retinal vessels, extensive white with pressure, lattice degeneration, marked meridional folds, optic atrophy and subnormal or normal electroretinograms. The main cause of blindness was retinal detachment of relatively poor surgical prognosis due to a variety of causes. Various types of retinal breaks were found in close association with vitreous and retinal disease. Early diagnosis of this disease is important. Members of the patient's family should be checked for retinal breaks. Prophylactic treatment for retinal detachment should be considered before cataract develops.
Degeneration (medical)
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Optic disc
Macula Lutea
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Five consecutive cases of multiple serous detachment of the retinal pigment epithelium (RPE) characterized by multiple discrete parafoveal retinal pigment epithelial detachments, with or without neurosensory detachment of the retina, atrophy of the overlying RPE, and characteristic angiographic findings are described. We believe that this entity is an early stage of the syndrome of senile disciform macular degeneration which is easily recognizable clinically and has a favorable prognosis following photocoagulation therapy.
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