Author: Renato Correia Barbosa
Co-authors: Carla Teixeira, Rita Basto, Ana Rita Viana, Alexandre Silva, Paula Tenedorio
Abstract
Purpose: Retinal pigment epithelium tears are rare spontaneous events that usually happen in AMD patients with pigment epithelial detachments. While they seem to be more common in patients undergoing anti-VEGF injections, they can occur spontaneously as part of the natural history of AMD, when the pigment epithelium is detached from the underlying Bruch’s membrane. The result of hydrostatic pressure caused by the fluids and materials occupying the detachment eventually causes the rupture of the RPE, which then tends to fold on itself. Visual acuity is usually dramatically decreased, especially if the tear involves the center of the macula.Setting/Venue: Ophthalmology department, Hospital Pedro Hispano, Matosinhos, Portugal.Hospital Pedro Hispano, Matosinhos, Portugal.
Materials and methods: Retrospective assessment of the clinical records, multimodal retinal imaging (color fundus photography [CFP] and fluorescein angiography [AF]), and spectral-domain optical coherence tomography (OCT).
Results: A 75-year-old female patient with a history of nonexudative age-related macular degeneration, first objectified 3 years before, presented to the emergency department with complaints of severe sudden vision loss of the right eye (OD). Her OD visual acuity was 1/10 and she was only able to see the optotype further to the right. The anterior segment examination was normal. Observation of the ocular fundus showed severe subretinal and retinal hemorrhage affecting a large portion of the macula, including the fovea. OCT findings corroborated the subretinal and sub-RPE hemorrhage. CFP and AF objectified a RPE tear. The patient was proposed to anti-VEGF intravitreal injections with aflibercept. In the following months, reabsorption of the hemorrhage occurred, and the giant EPR tear, involving most of the central macula, with the RPE folded on itself nasally to the fovea, became more evident. After 13 months of follow-up, the patient had a visual acuity of hand motion, with her central vision severely affected.
Conclusion: RPE tears may be part of AMD or other retinal disease’s natural history, and thus cannot be prevented in most cases. Tear size and involvement of the fovea are the most important prognostic factors regarding visual outcomes. Patients must continue to have a close follow-up and the underlying disease should continue to be treated, despite the poor functional outcome.
The authors have no conflicts of interest to declare.
