Long-term effects of drusenoid pigment epithelial detachment on the retina and the choroid

To analyze the long-term effects of drusenoid pigment epithelial detachment (DPED) on the overlying inner and outer retinal layers and the underlying choroid.

Forty-two eyes from 33 patients with DPED due to intermediate age-related macular degeneration were included in this prospective observational cohort study, which was conducted from December 2017 until July 2023. Patients underwent spectral-domain optical coherence tomography every 6 months. Evaluated parameters included maximum DPED height (=DPED apex) and location of the DPED apex at baseline; furthermore, DPED height, retinal thickness (RT), visibility of retinal layers, presence of hyperreflective foci (HRF), choroidal thickness (CT), and best-corrected visual acuity (BCVA) at baseline and each follow-up visit, as well as development of macular neovascularization or geographic atrophy.

DPED height, RT, and CT did not change significantly during the observation period (all p values > 0.05). DPED height and RT correlated significantly regardless of visit (estimate = -0.36, 95% CI = -0.4 to -0.32; p < 0.0001), DPED height, and CT did not (p > 0.05). Outer retina (estimate = -2.19, 95% Cl = -2.74 to -1.63; p < 0.0001), location in the central millimeter (estimate = -0.79, 95% Cl = -1.31 to -0.27; p = 0.004), and the presence of HRF (estimate = -0.65, 95% Cl = -1.05 to -0.24; p = 0.003) were significantly associated with retinal layer visibility regardless of visit, while DPED height was not (p > 0.05). BCVA was not significantly associated with DPED height, RT, CT, or the number of visible outer and inner retinal layers regardless of visit (all p values > 0.05).

Our results indicate that increasing DPED height may significantly reduce the thickness of the overlying retina but not of the underlying choroid. Fewer outer retinal layers were visible compared to the inner retina at the DPED apex. Location in the central millimeter of the macula and presence of HRF also reduced the number of visible retinal layers. Impairment of the retinal morphology, which seems to be more pronounced in the outer than the inner retina, need not be accompanied by functional impairment and can recover in case of DPED regression.