We read with great interest the case series presented by Chan et al,1 and agree that vascularised pigment epithelial detachments (vPEDs) do not flatten easily with anti-vascular endothelial growth factor (VEGF) treatment. As the authors discuss, the prospect of using a higher than conventional dose to treat this type of choroidal neovascular membrane needs evaluation, however, we question whether the cases demonstrated did in fact have vPEDs.

Case 1 shows a well-defined circular smooth area of fluorescence consistent with a serous PED next to an area of retinal pigment epithelial mottling. This may represent an adjacent area of occult, and or atrophy, judging from the colour photograph and optical coherence tomography (OCT). It is most likely that this is a retinal angiomatous proliferation (RAP) lesion that can respond well to conventional dose anti-VEGF treatment. Case 2 also appears to show serous PED. With Case 3 it is reported that there is a retinochoroidal anastomosis at the margin of the vPEDs. The colour photograph and OCT suggest that the lesion is a serous PED associated with RAP. Again in our experience this would settle well with conventional dose anti-VEGF treatment.2

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