Influence of the morphology metrics of serous PED in AMD on the success of triamcinolone acetonide monotherapy

Background: Serous detachment of retinal pigment epithelium (RPE) is a special form of age-related macular degeneration (AMD) and accounts for approximately 10% of all cases of exudative AMD. In the natural course of retinal pigment epithelial detachment (PED), RPE tear, subretinal neovascularization and RPE atrophy develop and are accompanied by severe and irreversible loss of central vision. Purpose: To determine the prognostic factors for success of triamcinolone acetonide (TA) for serous PED in AMD. Materials and Methods: Fifty-two patients (54 eyes) with serous PED associated with AMD who were treated with either intravitreal or subtenon TA were followed up over 36 months. At baseline and follow-up visits, they underwent general eye examination including visual acuity assessment, ophthalmoscopy, color fundus photography, long-wave fundusgraphy, fluorescein angiography and macular optical coherence tomography (OCT). Results: On the basis of a K-means cluster analysis we distinguished two categories of patients with serous PED, which differed in the values of two baseline indices (PED height and length). Over the follow-up period, complete re-attachment was achieved in 60% of cases having higher baseline PED height and more extensive (i.e., longer) baseline PED length versus 23.5% of cases having lower baseline PED height and less extensive baseline PED length (p = 0.01). Triamcinolone acetonide reduced significantly the height and length of PED in both categories of patients over 36 months, with their visual acuity remaining stable compared to the baseline values. Over the 36-month follow-up period, subretinal neovascular membrane developed in 7 (13%) eyes treated with TA. Conclusion: Higher and more extensive PEDs were found to predict a more favorable response to TA monotherapy. Following administration of TA, complete re-attachment was achieved in 60% of cases having higher baseline PED height and more extensive baseline PED length. Anatomical and morphological features of a serous PED have no effect on the frequency of subretinal neovascular membrane formation.