Acute tear of the retinal pigment epithelium (original) (raw)
Pathogenesis of tears of the retinal pigment epithelium
British Journal of Ophthalmology, 1984
This report confirms a previous report that elderly patients with serous detachments of the pigment epithelium prior to and after developing a pigment epithelial tear at one border present a characteristic ophthalmoscopic and fluorescein angiographic appearance. Evidence is presented that subpigment epithelial choroidal neovascularisation and not irregular separation of the basement membrane from its pigment epithelium is the primary cause of the detachment and tear in the pigment epithelium.
Bilateral tears of the retinal pigment epithelium
British Journal of Ophthalmology, 1988
This paper describes bilateral tears of the retinal pigment epithelium (RPE) which followed photocoagulation treatment of retinal pigment epithelial detachment (PED) in the right eye and which occurred spontaneously in the left eye. A 66-year-old Japanese male presented with PED approximately 4x 6 disc diameters in size in his right eye, and one disc diameter in the left eye, both in the macular regions. The right PED was treated by placing a row of argon laser photocoagulation along the margin of the PED, with avoidance of the papillomacular bundle. Five days after treatment the PED enlarged peripherally beyond the coagulated site. Nineteen days later an RPE tear developed at the temporal edge of the detachment in the right eye. The remaining detached RPE retracted centrally, forming curled folds. About 40 days after the initial examination the patient complained of sudden reduction of vision in his left eye. At this time an enlargement of the PED was found in his left eye. One week after this examination a small RPE tear was found in the nasal border of the PED in the left eye. The tear in the left eye gradually developed centrally to the fovea.
Tears of detached retinal pigment epithelium
British Journal of Ophthalmology, 1981
Ripping of detached pigment epithelium appears to be a common sight-threatening complication of pigment epithelial detachments and occurs at the junction of the detachment and flat pigment epithelium. The characteristics of the detachment prior to the rip suggest that the tear occurs in pigment epithelium which is detached without its basement membrane. The tear is followed by retraction of the pigment epithelium, revealing bare Bruch's membrane. The defect may remain apparently unaltered, or may be recovered by normal looking pigment epithelium, but most commonly is replaced by a fibrous plaque. Most patients had a profound reduction in visual acuity.
Blow-outs' in the retinal pigment epithelium
British Journal of Ophthalmology, 1987
A hole was detected in the epithelium of a retinal pigment epithelium (RPE) detachment in two patients. Leakage through the hole led to an elevation of the overlying neurosensory retina in each case. The resulting vision was 20/70 in one eye and 20/30 in the other. The defects in the RPE occurred in a setting different from that usually seen with tears in the pigment epithelium and had a different clinical appearance. Two patients were seen who had a defect in the epithelium of a retinal pigment epithelium (RPE) detachment underlying a neurosensory retinal elevation. These defects were confirmed by stereo- biomicroscopy and stereophotography. They were not similar to the RPE rips or tears which have been previously described.'"' Fluorescein angiography demonstrated intense leakage through the defects in each case. In one patient the evolution of the defect suggested that build-up of fluid pressure in the RPE detachment led to a 'blow-out', causing the defect and subsequent intense leakage with its overlying' neurosensory detachment. We believe our patients had a variant of central serous choroidopathy, and the observations made here on the aetiology of the Correspondence to
Retinal Pigment Epithelium Tears in Younger Patients: Causes and Consequences
Acta Medica Medianae, 2020
We present three different cases of patients with retinal pigment epithelium (RPE) tear: one case with choroidal osteoma, one with central serous chorioretinopathy (CSHR) and one with idiopathic polypoidal vasculopathy (IPCV). Fotodocumentation, fluorescein angiography, optical coherence tomography (OCT) and OCT angiography showed typical choroidal neovascularization in patient with osteoma and IPCV. In patient with CSHR, large PED without choroidal neovascularization was present. PED tear was detected in all patients. Various eye disorders, such as tear of retinal pigment layer, can complicate clinical picture and be associated with PED. Large height and diameter of PED, association with CNV, small ratio of CNV size to PED size, lines in infrared images, and duration of PED may predict the course of RPE tear. Therefore, it should be monitored for this complication. Treatment and outcome depends on cause of tear.
Retinal Cases & Brief Reports, 2018
Purpose: To report a patient presenting a retinal pigment epithelial tear in which optical coherence tomography angiography enabled the visualization of subfoveal choroidal neovascularization (CNV) not evidenced by the fluorescein angiography. She was treated with 3 monthly intravitreous anti-VEGF injections and intraretinal fluid resolution occurred. Methods: Observational case report. Results: A 62-year-old Caucasian woman presented with decreased visual acuity in the right eye for 3 months. Fundus biomicroscopy revealed a yellowish macular lesion associated with intraretinal hemorrhage. Fluorescein angiography showed a large hyperfluorescent area consistent with window defect. Optical coherence tomography showed a retinal pigment epithelial tear with subretinal fluid. However, there was no clear evidence of CNV on fluorescein angiography or OCT. Optical coherence tomography angiography confirmed the presence of an active CNV by the visualization of the neovascular network in the region corresponding to the scrolled up retinal pigment epithelium. Conclusion: This case report demonstrates that optical coherence tomography angiography can be useful to confirm the presence of CNV in cases where fluorescein angiography and OCT cannot establish the diagnosis. The reported case suggests the applicability of optical coherence tomography angiography in patients in whom retinal pigment epithelial tear is detected and associated CNV is suspected.
Journal of Cataract and Refractive Surgery Online Case Reports, 2014
A 66-year-old man was referred to our clinic with decreased vision in the left eye. Nine days earlier, the patient had had uneventful phacoemulsification with intraocular lens (IOL) implantation in the left eye. The preoperative examination showed a cortical nuclear cataract and a normal fundus. One day post surgery, visual acuity in the left eye had deteriorated, and at the time of referral, the corrected distance visual acuity was 20/160. Fundus biomicroscopy and optical coherence tomography showed a retinal pigment epithelial tear with subretinal fluid collection involving the macula. Fluorescein angiography showed no choroidal neovascularization on the macula. We report a case of retinal pigment epithelial tear after uneventful phacoemulsification with posterior chamber IOL implantation in an eye that was normal except for the presence of an immature cataract.
British Journal of Ophthalmology, 2012
Aim To study tissue remodelling and wound healing after retinal pigment epithelium (RPE) tears due to age-related macular degeneration. Methods Retrospective longitudinal study of 36 eyes (33 patients) with RPE tears. Imaging was performed using fundus autofluorescence (FAF) (l¼488 nm) and spectral-domain optical coherence tomography (SD-OCT). Presence of intraretinal hyper-reflective dots in SD-OCT, which correlated with hyperfluorescent dots in FAF, indicating RPE migration was studied. Morphology of subretinal mass and RPE layer integrity in the RPE denuded area over time were examined. Results 7 of 36 eyes (19.4%) showed patchy or hazy hyperfluorescent areas in FAF, and the majority of eyes (83.3%) showed hyper-reflective dots, which possibly represent intraretinal RPE migration and hard exudates. Homogenous subretinal mass was encountered in about half of all cases. In one case (2.8%), the RPE layer proliferated and covered the defect. Conclusions SD-OCT and FAF showed a considerable amount of RPE proliferation, migration and repopulation. Intraretinal RPE migration did not form a functional RPE layer. A small defect might be repaired by cell proliferation. But this RPE proliferation is not sufficient to cover large defects.
Retinal Pigment Epithelial Detachment
Survey of Ophthalmology, 2007
Detachment of the retinal pigment epithelium is a prominent feature of many chorioretinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase ''detachment of the retinal pigment epithelium'' is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations. (Surv Ophthalmol 52:227--243, 2007. Ó 2007 Elsevier Inc. All rights reserved.)
A new perspective on Bruch's membrane and the retinal pigment epithelium
Trypsin digestion of retinal pigment epithelium is a technique that bares Bruch's membrane, to allow topographical examination by scanning electron microscopy. Twenty-five human eyes were examined. The zonula occludens of the pigment epithelium was clearly seen as a surface feature, but attachment plaques at the sides and base were not visible. The adhesion between the pigment epithelium and the basal lamina was stronger than between the basal lamina and the rest of Bruch's membrane. Surface features of the basal lamina, inner collagenous zone, elastic layer, and outer collagenous zone were seen in a way that previously required an artist's representation constructed from microscopic sections.
Scientific Reports, 2019
The purpose of this study was to evaluate focal damage in the retinal pigment epithelium (RPE) layer in serous retinal pigment epithelium detachment (PED) with multi-contrast optical coherence tomography (OCT), which is capable of simultaneous measurement of OCT angiography, polarization-sensitive OCT and standard OCT images. We evaluated 37 eyes with age-related macular degeneration that had serous PED. Focal RPE damage was indicated by hyper-transmission beneath the RPE-Bruch’s membrane band in standard OCT images. Distribution of RPE melanin was calculated using the dataset from multi-contrast OCT. Twenty-four points with hyper-transmission were detected in 21 of the 37 eyes. Standard OCT images failed to show disruption of the RPE-Bruch’s membrane band at 5 of the 24 hyper-transmission points. Conversely, multi-contrast OCT images clearly showed melanin defects in the RPE-Bruch’s membrane band at all points. Areas of melanin defects with disruption of the RPE-Bruch’s membrane ba...
Eye, 2005
PurposeTo describe retinal pigment epithelial tear following photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).DesignRetrospective interventional case series.MethodsA retrospective study in an institutional practice. We describe seven cases of retinal pigment epithelial (RPE) tear, which developed in seven eyes of seven patients following PDT. All eyes had subfoveal CNV secondary to AMD.ResultsSix eyes had
Investigative Ophthalmology & Visual Science, 2004
PURPOSE. The purpose of this study was to monitor temporal changes in the retina, retinal pigment epithelium (RPE), and choroid of chick eyes using biometric, ultrastructural, and elemental microanalysis techniques as a means of visualizing more detailed signs of the physiological processes underlying choroidal expansion and refractive normalization during recovery from form deprivation. METHODS. Axial dimensions and refractions were measured on form-deprived and fellow eyes of 117 experimental chickens reared with monocular translucent occlusion from days 1 to 15 and given different lengths of visual experience (T ϭ 0 -144 hours) before death. Tissue was analyzed ultrastructurally by electron microscopy and relative sodium (Na) and chloride (Cl) ion abundances, by using x-ray microanalysis to determine changes in the presence of these indicators of tissue hydration. RESULTS. Refractive error decreased from more than 20 D of myopia almost linearly over the first 144 hours after occlusion. Concurrent changes in thickness in the retina, RPE, and choroid were seen as a series of thickness increases and edema, which returned to normal thickness, first in the retina, and did not reach maximum until 3 days after occluder removal in the choroid. In freeze-dried tissue, Na and Cl ion concentrations were greatest in the RPE photoreceptor outer segments and extravascular choroid at T ϭ 0, decreasing toward fellow eye levels by T ϭ 48 in the RPE and choroid. Na and Cl ion abundances in the frozen lymph of choroidal lymphatics were nearly at control levels (T ϭ 0) and increased later as the vessels became more distended after the extravascular edema became significant. CONCLUSIONS. The results suggest that occluder removal induces edema across the retina and choroid and that this fluid may be the vector eliciting choroidal expansion during recovery from form deprivation possibly driven by the hyperosmolarity in the choroid, RPE, and photoreceptor outer segments that accompanies deprivation. (Invest Ophthalmol Vis Sci. A R T I C L E S FIGURE 8. Electron micrograph of Bruch's membrane in a normal chick. (A) Basal membrane of RPE composed of fine filaments extending from basal surface of cells of RPE. (B) Inner collagenous zone composed of interwoven collagen filaments. (C) Noncontinuous elastic layer. (D) Outer collagenous zone. (E) Basement membrane of choriocapillaris. Note regularity of infoldings of the basal membrane of RPE cell.
American Journal of Ophthalmology, 2006
PURPOSE: To detect patients with neovascular age-related macular degeneration (AMD) who experience retinal pigment epithelium tears after initial verteporfin therapy combined with intravitreal triamcinolone during early follow-up. DESIGN: Prospective interventional case series. METHODS: Forty-five consecutive patients with choroidal neovascularization (CNV) in AMD were treated with verteporfin therapy combined with 4 mg of intravitreal triamcinolone. Optical coherence tomography (OCT), visual acuity, and fluorescein angiography were performed. RESULTS: Two eyes with a predominantly classic CNV developed a retinal pigment epithelium tear. An early onset tear could be differentiated from a delayed onset tear. OCT showed an increased depth signal in areas of missing retinal pigment epithelium and a wavy, contracted, and elevated retinal pigment epithelium band. CONCLUSIONS: Retinal pigment epithelium tears can occur despite adding intravitreal triamcinolone to verteporfin therapy. OCT shows characteristic changes in the evolution of retinal pigment epithelium tears after combination therapy. (Am J Ophthalmol 2006;141: 396 -398.