TREATMENT OF PIGMENT EPITHELIAL DETACHMENTS IN THE ELDERLY PATIENT

After the early attempts to treat detachment of the retinal pigment as part of age-related macular degeneration, it became clear that there was no therapeutic benefit and that the results were unpredictable. The disappointing outcome to treatment could be the result of two factors. First, there is considerable uncertainty about the pathogenesis of the lesion. Second, angiography using fluorescein sodium does not reveal the site of choroidal neovascularization that is believed to be a major source of the fluid within the subpigment epithelial space. Two recent publications on therapy suggest that the therapeutic options are now clearer. In each report, new clues as to the location of the new vessels have been used to direct treatment and this finding has been accompanied by success. In one instance, the notch was shown by angiography using fluorescein; in the other instance, focal hyperfluorescence as shown by indocyanine-green was photocoagulated. In both instances, more than 50% of the lesions that were treated flattened after treatment with improvement of vision.