Good Hope Eye Clinic

Occult with PED type of wet ARMD

David Kinshuck

 

Vascularised PED: (Occult CNV type 1)

 

 

occult cnv with a PED (a type of macular degenerationa PED..pigment epithelial detachment type of wet ARMD, with CNV (choroidal neovascularisation): occult type 1. This condition usually progresses, but progression rates are very variable.

 

In this type of wet ARMD the damaged area looks like a dome, but in addition fluid leaks under the retina, hence the term 'wet'.

Anti-VEGF drugs generally help. The PED may reduce in size with treatment, and treatment will reduce intraretinal and subretinal fluid. Retina 2011. Occasionally the retina may 'rip', causing more loss of sight Eye 2011. Overall, 15% of PEDs rip, but the risk is proportional to the PED size, so a large PED is much more likely to rip. The rip typically occurs 2 months after starting Lucentis. The rip may not cause that much visual loss initially, but central vision may get worse over time.

 

a vascularised PED (a type of wet ARMD)

November, 7 months later, a PED has developed, with a retinal haemorrhage. Also, intraretinal and subretinal fluid.

Patient, age 86, April, reasonable vision 6/24 Photo / OCT show drusen, hard and soft enlarge

Professionals

  • ARMD with a PED is classified as 'occult' CNV, type 1.  Outcomes Eye 11
  • Look for polyps,    see   PCV.
  • photo  case 9 r/l     left     case.
  • There are 3 types of PED, reviewed here (avascular, occult, polypoidal). 
  • photo avascular ped
  • intraretinal cysts indicate a poorer response BJO14
  • combined with geographic atrophy BJO 14
  • treatment helps stabilize/improve SIO 15
  • fluid fluctuates with injections every 2 months
  • serous PEDs respond better Retina 16; switich antiVEGF if response poor.
  • incomplete response to antiVEGF AJO 16