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Vascularised retinal pigment epithelial detachment (PED): Occult CNV type 1

In a few people, the dry macular degeneration turns into this type of ARMD. Occasionally, there may have been no obvious 'dry' changes visible before this develops. In this type the damaged area looks like a dome. Fluid leaks under the retina, hence the term 'wet'. Anti-VEGF drugs are used, although is not always effective. Occasionally these drugs can cause the retina to '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. The PED will not reduce in size with treatment, but treatment will reduce intraretinal and subretinal fluid. Retina 2011 Generally ARMD with a PED is classified as 'occult' CNV, type 1. Outcomes Eye 11 Avascular PED There is another type of PED without any vascular element. In younger patients this is usually part of Central  Serous Retinopathy. In older patients this is usually part of ARMD, and is classified as an avascular or serous ped: anti-growth factor treatment is not helpful (Eye 2010). However, if the other eye has had wet ARMD, then such as eye is at very high risk of wet ARMD itself. Eye 2012  Really (I suggest) that such eye should have regular OCT examinations, perhaps every 3 months: as yet there is no evidence to prove that this will help, but logically it will help by detecting very early disease that is much easier to treat.

a 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. a photo  case 9 r/l left See a case. There are 3 types of PED, reviewed here (avascular, occult, polypoidal).   photo avascular ped

there is a 'PED' only, no leak	enlarge	'PED', with a leak under the retina (shown here) or in the retina

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