Treatment of Neovascular Age Related Macular Degeneration Associated with Pigment Epithelial Detachment: An Update

Ali Dirani1* and Ghassan Cordahi1 1Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada Retinal pigment epithelial detachment (PED) is defined as an anatomical separation of the retinal pigment epithelium (RPE) from the underlying Bruch layer [1]. Serous and vascularized (fibrovascular) PED are commonly present in eyes with neovascular AMD. According to some studies, up to 31% of patients with neovascular AMD (nAMD) present with serous PED or vascularized PED [2,3]. In general, patients with PED were excluded from randomized controlled trials evaluating the efficacy of Ranibizumab (Lucentis; Novartis Pharma AG, Basel, Switzerland) and Aflibercept (Eylea; Bayer Schweiz AG, Zurich, Switzerland) in the treatment of neovascular AMD. Our knowledge about the subgroup of patients with neovascular AMD associated with PED is based on retrospective small monocentric studies, extension of results of bigger clinical trials and rare post hoc analysis of clinical trials. The presence of PED can be a risk of poor or non response in patients with AMD: Suzuki et al had shown that the presence of vascularized and serous PED were risk factors of non-response to anti-vascular endothelial growth factor (VEGF) treatment in terms of visual acuity (VA) improvement, and vacularised PED was a risk factor for non response in terms of resolution of exudative activity based on fundus examination and optical coherence tomography findings [4].