50. A pigment epithelial detachment (PED) with homogenous material
A 75-year-old man presents with distorted vision. Here is his OCT. What is the cause of the distortion?
This lesion is most compatible with a drusenoid pigment epithelial detachment (DPED) as there is a clear separation of the retinal pigment epithelium (RPE) from Bruch’s membrane (confirming a PED). Additionally, the material contained within the PED is homogenous in nature and is relatively hyperintense (a serous PED has reduced intensity). No subretinal fluid or intraretinal fluid is present – which is evidence suggesting that this is not a fibrovascular PED. Additionally, with a fibrovascular PED (occult CNV) the material under the PED would be heterogeneous and may be lamellar in nature. While choroidal melanoma should always be considered in any dome-shaped elevation of the RPE, this not a choroidal melanoma as it is the RPE, and not the choroid, that is elevated. There is also some faint orbital shadowing present. These lesions do need to be followed as they are at moderate risk of developing choroidal neovascularization (CNV).
With a DPED, the material under the RPE is homogenous and of moderate intensity.
Suggested follow-up / referral
Drusenoid PED is a high-risk lesion for conversion to wet AMD and therefore, referral is warranted.