Lipid exudation in age-related macular degeneration

We reviewed the relationship between lipid exudation and subretinal neovascular membranes associated with age-related macular degeneration. The records of 500 consecutive patients with subretinal neovascular membranes caused by age-related macular degeneration were examined. Seventy-five patients (15%) (85 eyes) manifested lipid exudation in conjunction with subretinal neovascularization. Twelve patients (2.4%) (13 eyes) had a massive lipid exudative response with extensive serous retinal detachment (resembling Coats' disease). Of the 85 eyes with subretinal neovascular membranes and lipid exudation, 71 (84%) had a subretinal neovascular membrane that was classified as ill defined. Improvement of vision with or without treatment was seen in only 14 of these 85 eyes (16.4%). After comparing these 85 eyes to 94 eyes from 76 patients with age-related macular degeneration and subretinal neovascular membranes but no lipid exudation, we found that a subretinal neovascular membrane associated with lipid exudation was more likely to be ill defined (71 eyes [84%] vs 35 eyes [37%]; P = .0001), was more frequently associated with retinal pigment epithelial detachment (30 eyes [35%] vs 15 eyes [16%]; P = .0029), and was more likely not to have stabilization of visual acuity (14 eyes [16%] vs 31 eyes [33%]; P = .025).