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Approaching serous PED

Serous PED is a result of fluids leak via Bruch’s membrane to space between Bruch’s and RPE, causing an increased in hydrostatic pressure separating RPE from Bruch’s membrane.


Fundus image 


On clinical examination, a smooth, well-defined border of RPE elevation along with a slight pale appearance
PED is associated with subretinal fluid or intraretinal hemorrhage.


Fundus image showing serous PED with subretinal fluids and drusen
Fundus image showing serous PED with subretinal fluids and drusen



Optical coherence tomography 


On OCT, PED features smooth or irregular RPE elevation, which contains clear fluids that looks like a homogeneous hyporeflective area. PED may feature sub / intraretinal fluids accompanied by ellipsoid zone disruption.

OCT cross-section showing serous PED with subretinal and intraretinal fluids
OCT cross-section showing serous PED with subretinal and intraretinal fluids




Fluorescein fundus angiography


On FFA, serous PED shows a distinct area of early hyperfluorescence, which increases in the mid and late phase due to dye pooling.

FFA is useful to detect the presence of neovascular membrane.


Fundus image showing serous PED and subretinal fluid and hemorrhage
Fundus image showing serous PED and subretinal fluid and hemorrhage 
Early phase FFA showing early hyperfluorescence from CNV
Early phase FFA showing early hyperfluorescence from CNV and subretinal fluids

Mid phase FFA showing increased hyperfluorescence from CNV, subRPE and subretinal fluids
Mid phase FFA showing increased hyperfluorescence from CNV, subRPE and subretinal fluids

Late phase FFA showing increased hyperfluorescence from CNV with subRPE pooling increasing in intensity without changing it borders or leaking and subretinal fluids pooling
Late phase FFA showing increased hyperfluorescence from CNV with subRPE pooling increasing in intensity without changing it borders or leaking and subretinal fluids pooling


Management

 

Treating serous PED is a clinical challenge with poor prognosis; however, better treatment response to VEGF trap (Aflibercept or Conbercept) in contrast to Anti VEGF (Bevacizumab or Ranibizumab).
If PED presented without any other retinal features such as active CNVm does not warrant treatment as regressing PED alone won’t improve vision or prognosis.


Please check Clinical guidelines for ARMD and course of clinical changes in RPE

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