25. SRF with PED
An 89-year-old woman presents with new distortion on her Amsler grid. Her OCT is below. What is the cause of her distortion?
In this scan there is a large elevation in the deep retina. Here, the RPE has lifted off Bruch’s membrane, creating a retinal pigment epithelial detachment (PED). In addition, there is evidence of subretinal fluid (SRF). The PED is irregular, as it appears to be bilobed (notched) in nature. The material underneath the PED is heterogeneous in nature, with areas of hyper-reflectivity on the nasal aspect and hyporeflective in deeper structures. There also appears to be a lamellar nature to some of the material. Anterior to the PED, there is also layered hyperreflective material consistent with subretinal hyperintense material (SHRM).
Overall, this lesion is consistent with a fibrovascular PED or occult choroidal neovascular membrane. The distortion is caused by a number of things including the SRF, and the PED.
If a PED is irregular and associated with heterogeneous material, it is likely to be a fibrovascular PED.
Suggested follow-up / referral
Any person with a fibrovascular PED needs urgent referral for management.