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Histoire naturelle d’un décollement drusenoïde de l’épithelium pigmentaire associé à une DMLA : résolution spontanée

Pigment epithelial detachment (PED) is defined as an anatomical separation of the retinal pigment epithelium from the underlying Bruch's membrane. Drusenoid PED is the form of PED that evolves from the confluence of serous and bulky drusens. It can appear in several retinal pathologies, but age-related macular degeneration (AMD) remains the most common association. Drusenoid PED is a precursor of geographic atrophy in AMD.The purpose of our work is to describe a spontaneous evolution of drusenoid PED associated with AMD.

We report the case of a 76-year-old man, pseudophakic in both eyes. He is followed for dry AMD associated with a bilateral PED for five years.

The visual acuity of the right eye was 5/10, left eye 7/10, P2 in both eyes with correction (addition of 2.75). Examination of the anterior segment was normal with presence of an implant in the capsular bag on both sides. The ocular fundus found the presence of multiple serous drusens at the posterior pole with presence of pigment migrations. 

Optical coherence tomography (OCT) demonstrated an increased central macular thickness with presence of serous drusens. It was associated with a drusenoid PED and pigment migrations without any exudative sign. A beginning of epimacular membrane in the right eye should also be noted. Fluorescein angiography found a slight hyperfluorescence in the early phase that increased during the procedure, without late leakage. Infracyanine green angiography demonstrated hypofluorescence of PED throughout the angiographic sequence without any sign of exudation.

The spontaneous evolution, without treatment or modification of eating or lifestyle habits, was marked by the spontaneous resorption of the drusenoid PED in the two eyes. The bilateral PED remained avascular after five years of evolution. In addition, the visual acuity from far to near remained stationary.

The spontaneous evolution of the drusenoid PED can be done according to three modes. The following are listed in order from most likely to least likely :

* Persistence of the PED +

* Development of neovascularization ++

* Evolution towards geographic atrophy +++. 

The most common evolution of drusenoid PED is atrophy. It can be explained by the fact that the function of the pigment epithelial declines with age. This could be seen as a result of the prolonged separation of the chorio-capillary, resulting in atrophy of pigment epithelial, loss of photoreceptors and disappearance of PED.