|Year : 1987 | Volume
| Issue : 2 | Page : 61-63
Detachment of RPE and sensory retina in senile maculopathy
Eye Micro Surgery Centre, 2 Russell Street, Calcutta-700 071, India
Eye Micro Surgery Centre, 2 Russell Street, Calcutta-700 071
Source of Support: None, Conflict of Interest: None
Detachment of RPE and sensory retina in 28 eyes having Senile Macular Degeneration is described.
|How to cite this article:|
Pahwa V. Detachment of RPE and sensory retina in senile maculopathy. Indian J Ophthalmol 1987;35:61-3
In exudative senile macular degeneration, breaks in the Bruch's membrane allow choroidal neovascularisation to proliferate beneath the retinal pigmented epithelium (RPE). Serous extravasation or bleeding from these new vessels produce a detachment of RPE (serous or haemorrhagic). Frequently there is detachment of the overlying sensory retina as well . The haemorrhage sometimes breaks through the retina and extends into the vitreous or lies in the pre-retinal location .
| Materials and Methods|| |
28 eyes of 18 patients (16 males and 2 females) having exudative senile maculopathy (early disciform) were selected for this study 10 patients had bilateral involvement The average age was 67 years, the minimum being 60 and the maximum 79. Diabetes was seen in 4 patients (without Retinopathy). Patients with late disciform stage of the disease were not included in this study. Fluorescein angiography was done in these patients to detect sub-retinal neovascular membrane (SRNVM) and to confirm the detachment of RPE and sensory retina
| Observations|| |
Drusen were seen at the posterior pole and they varied in number, shape and in pattern of distribution. The serous detachment of RPE was seen ophthalmoscopically as elevated oval to round, yellow gray lesions with sharply circumscribed margins [Figure - 1]. Haemorrhagic detachments of RPE were solid and dark gray in colour [Figure - 2]. Sometimes a darker appearing subpigment epithelial haemorrhage was surrounded by areas of red at the margins where the blood had broken through the RPE Hard yellow exudates in the retina and sub-retinal precipitates were often seen. Varying amounts of hypo and hyper pigmentation were also observed Fluorescein angiography showed earlyfluorescence of drusen and staining. SRNVM were observed in the early phase of fluorescein angiography as a typical lacy pattern [Figure - 3] which extravasated fluorescein In presence of sub-retinal haemorrhage the choroidal fluorescence was completely or partially blocked. In such cases a good definition of SRNVM was hard to get The distribution of the lesions were either foveal, macular, perimacular or juxta-papillary
| Discussion|| |
Sub-retinal neovascular membrane extravasates serous fluid or blood which detaches the RPE
and sensory retina. This membrane usually originates from the choriocapillaries but sometimes from the larger choroidal vessels (3).
[Figure - 4][Figure - 5] show the fluorescein angiographic picture of serous detachment of RPE and sensory retina It was seen that RPE detachment was almost always associated with detachment of the sensory retina, which usually showed cystoid macular oedema Commonly serous and haemorrhagic components were seen to coexist
The visual acuity was grossly affected in all these eyes. The best corrected visual acuity varied form HM to 6/18. However, it was marginally better in cases of serous detachment than in eyes having haemorrhagic detachment of RPE Out of these 28 eyes laser photocoagulation of SRNVM was considered in only 3 eyes The criteria for selection was good definition of SRNVM on fluorescein angiography and its location away from the avascular zone of the fovea. In these 3 eyes the visual acuity has been maintained (8 months follow-up) and SRNVM have been obliterated. In the remaining 25 eyes the SRNVM was either located in the avascular zone of the fovea or were partially or totally obscured by the sub-retinal haemorrhage.
Follow-up studies showed that five eyes having serous detachment of RPE, transformed into haemorrhagic detachment (earliest was seen after 23 days and latest was by 3 1/2 months). Bleeding from the SRNVM caused the blood to collect in the sub-pigment epithelial and subretinal space In 2 eyes it was found that this subretinal haemorrhage broke through the retina into the vitreous and caused pre-retinal and localised posterior vitreous haemorrhages.
The visual acuity in these eyes deteriorated with the proliferation of pigmented epithelium and fibrous tissue and formation of a dense fibrous scar. The separated retina showed cystoid macular changes Fluorescein angiography in this stage showed irregular staining in the area of fibro-vascular tissue and residual blood pigments and low grade extravasation from the capillaries or larger vessels
| References|| |
Teeters, and Bird, 1973, Am. J. Ophthalmol. 76: 1.
Gass, 1973, Arch. OphthalmoL, 90: 206. 3. Sarks, 1973., Br. J. OphthalmoL, 57: 951.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1]