Pigment Epithelium Detachment

AMD demonstrating pigment epithelial detachment associated with soft drusen. Note also some hard drusen and areas of pigment clumping. 

  • Not an uncommon finding in AMD
  • Drusenoid PED may be formed by coalesced multiple large, soft drusen.

Clinical features:

  • Symptoms: reduced vision and metamorphopsia
  • Signs:
    • Typically appears as dome-shaped, round or oval elevation of the RPE and its underlying basement membrane
    • A detachment of the overlying neurosensory retina may be an evidence of subretinal neovascularization
    • Smooth or homogenous RPE overlying the PED
    • May be associated with overlying pigment clumping or atrophy
    • May remain stable for several years, but eventually flatten and lead to geographic atrophy of the RPE

Fluorescein angiogram:

  • Gradual and uniform staining of the sub-RPE material
  • Multiple areas of intense, late hyperfluorescence and "notching" of the uniform hyperfluorescent pooling defect are signs of underlying occult subretinal neovascularization