Retinal pigment epithelial detachments in the elderly: classification and outcome.

Sixty-four eyes of 57 elderly patients with pigment epithelial detachments (PEDs) were studied with the aim of describing their morphological features and identifying prognostic factors. They were classified into four groups according to the following characteristics: early fluorescence, late fluorescence, shallow detachment with limited fluorescence ('drusen type'), irregular fluorescence. The following conclusions were drawn: 30% developed demonstrable subretinal new vessels; all groups except the drusen type were susceptible, the irregular group being particularly prone. 10% developed retinal pigment epithelial tears, and these occurred almost exclusively in the slow fluorescent group. Flattening of PEDs was a feature of drusen type and early fluorescent groups. Most patients lost vision. RPE tears occurred within a few months of presentation with immediate loss of vision; likewise rapid loss of vision followed the development of demonstrable new vessels, though not necessarily in those with changes thought to imply the presence of new vessels. Flattening after prolonged detachment was associated with pigment epithelial atrophy and invariable loss of vision. Visual acuity was maintained consistently only in those eyes with persistent detachment.