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Serous PED Case report and Discussion

A 78 years old lady pseudophakic presented to me with reduced vision. Her BCVA is Hand motion in her Right eye, while in her left eye, the BCVA is 20/40 fundus examination showed drusen and signs of dry, moderate ARMD.


Clinical examination shows a smooth, well-defined border of RPE elevation and a slight pale appearance accompanied by subretinal fluid and exudation, along with drusen and subretinal scar.


Optical coherence tomography 


OCT features smooth RPE elevations, which contains clear fluids that look like a homogeneous hyporeflective area with subretinal fluids accompanied by ellipsoid zone disruption and intraretinal cysts.

OCT cross-sections of serous PED pre and post treatment with intravitreal Aflibercept
OCT cross-sections of serous PED pre and post treatment with intravitreal Aflibercept


Diagnosis: 

This is a case of neovascular advanced ARMD with serous pigment epithelial detachment


Management


This patient managed with monthly intravitreal Aflibercept for three consecutive injections. Post-treatment OCT cross-section shows resolving both subretinal fluid and serous PED and improved vision to counting fingers patient was followed up using PRN protocol.


Discussion


Wet ARMD can present as serous pigment epithelial detachment, which features a fluid leak via Bruch’s membrane to space between Bruch’s and RPE, causing increased hydrostatic pressure separating RPE from Bruch’s membrane, causing disturbance of outer retinal tissue such as ellipsoid zone and scar formation.


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).


This case was treated with intravitreal Aflibercept for three consecutive monthly injections. Post-treatment OCT shows improvement in terms of PED, showing that both subretinal fluid and serous PED with BCVA improved to counting fingers and not better due to disturbed ellipsoid zone and subretinal scar.


Please tell me how you would manage this case in your clinical practice??!!! 


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

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  1. dralioptometryApril 18, 2022 at 9:47 PM

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