History

73-year-old male with History of AMD presents complaining of decreased vision in the left eye for the past few days. He had seen 3 months prior and diagnosed with Retinal pigment epithelial detachment with good stable visual acuity and no treatment was recommended.

Medical History

• Hearing loss

Examination

• Vision (best corrected): 20/50 OD and 20/100 OS
• Pupils: Round and reactive without APD
• Motility: Full OU
• Intraocular pressures: Normal OU
• Slit lamp examination: Significant for NSC OU
• Fundus Examination:
• OD: Dry ARMD
• OS: See photographs

A - color

Ancillary Tests

• Fluorescein Angiogram

A.		B.
D.		E.

Fluorescein Angiography

Shows an area of intense hyperfluorescence corresponding to the bare choriocapillaris seen on the color pictures. Immediately adjacent to that is an area of blocked fluorescence with the characteristic sharp edge. These findings are consistent with a tear of the retinal pigment epithelium.

Diagnosis

Tear of the Retinal Pigment Epithelium

An acute tear of the RPE is a rare complication of pigment epithelial detachments (PED). The tear occurs at the margin of the PED with retraction of the torn edge underneath the already elevated pigment epithelium giving the characteristic blockage with clear margin. This causes the exposure of the choriocapillaris, which leaks the dye within the confines of the tear.

Risk factors for a tear of a PED are laser treatment, acute change of the size of the PED and the presence of a CNV. Visual acuity is usually poor following RPE tears even if the tear does not extend into the foveal center. No treatment is available for this condition.