Case 8-22. Fibrovascular Pigment Epithelial Detachment
A 63-year-o]d woman with a history of age-related macular degeneration was evaluated for a decline in her reading vision in her right eye over the previous two weeks. Her visual acuity in this eye was 20/400. Dilated fundus examination (A) revealed a pigment epithelial detachment with mottled pigmentation in the central macula surrounded by a large cuff of serous subretinal fluid. Fluorescein angiography (B) showed a bilobed region of hyperfluorescence within a large hypofluorescent lesion. The hyperfluorescent areas increased in intensity and size as the study progressed. A hyperfluorescent rim was noted surrounding the entire lesion.
A linear section (C) superior to the fovea showed two elevations of the retinal pigment epithelium, with mild backscatter persisting beneath both lesions consistent with fibrovascular pigment epithelial detachments. The reflection bounding the posterior neurosensory retina also appeared thicker in the region of the detachments suggesting neovascularization, A small collection of subretinal fluid was observed between the two detachments.
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