case_images: PMC10062083_01
case_images: Left eye - OCT images: at presentation, subfoveal PED with serofibrinous subretinal exudation and the edge of the RPE rip on the temporal side (a), and RPE aperture (encircled area) within the serous PED superonasal to the fovea (b), At 1-month post-PDT, flattening PED (c), and healing RPE aperture with reduced subretinal exudation (d), at 6-month post-PDT, completely flattened PED and healed RPE aperture (e and f, respectively). OCT: Optical coherence tomography, PED: Pigment epithelial detachment, RPE: Retinal pigment epithelium, PDT: Photodynamic therapy
case_images: OJO-16-170-g001.jpg
case_images: PMC10062083_01_OJO-16-170-g001.jpg
case_images: F1
case_images: Optical coherence tomography (OCT) of the LE showed a subfoveal serous PED with an RPE aperture on the nasal aspect, subretinal fluid (SRF) with fibrinous exudation, and a large extramacular RPE rip temporally [Figure 1a and b]. At the 1-month post-PDT visit, BCVA of the LE remained the same (20/30) with OCT showing healing RPE aperture, reduction in PED height, and resolving SRF, fibrin, and exudative retinal detachment [Figure 1c and d]. At 6-month follow-up, the LE had improved to a BCVA of 20/20, completely resolved PED, healed RPE aperture, and normal foveal contour [Figures 1e, f, and 2e].
case_images: Left eye: FA image at the first presentation showing window defect corresponding to large extramacular RPE rip and RPE aperture (encircled area) in the early phase (a), and leakage through RPE aperture with hyperfluorescence corresponding to RPE rip in the late phase (b). ICGA images showing hypocyanescence corresponding to the foveal PED and hypercyanescence through the rip in the early phase (c), and pooling of dye around RPE aperture and choroidal hyperpermeability in the late phase (d). Color fundus image at 6 months showing RPE atrophic changes at the macula and the scarred RPE rip (e). FA: Fluorescein angiography, PED: Pigment epithelial detachment, RPE: Retinal pigment epithelium, ICGA: Indocyanine green angiogram
case_images: OJO-16-170-g002.jpg
case_images: PMC10062083_01_OJO-16-170-g002.jpg
case_images: F2
case_images: Fluorescein angiography (FA) of the LE showed window defect corresponding to RPE rip as well as the RPE aperture, and an early hyperfluorescence with late leakage along the temporal edge of the RPE aperture [Figure 2]. At 6-month follow-up, the LE had improved to a BCVA of 20/20, completely resolved PED, healed RPE aperture, and normal foveal contour [Figures 1e, f, and 2e].
case_images: Right eye: Early phase FA and ICGA showing hypofluorescence corresponding to the asymptomatic bullous PED at initial presentation (a and b), Color fundus image, at 6 months, showing macula involving large crescent-shaped RPE rip (c), Mid-phase FA image at 6 months showing large window defect corresponding to the Grade-4 RPE rip with two focal leaks temporal to the rip (encircled areas) (d). FA: Fluorescein angiography, PED: Pigment epithelial detachment, RPE: Retinal pigment epithelium, ICGA: Indocyanine green angiogram
case_images: OJO-16-170-g003.jpg
case_images: PMC10062083_01_OJO-16-170-g003.jpg
case_images: F3
case_images: The RE fundus showed a large serous PED, with FA and OCT confirming the same without any SRF and leakage [Figures 3a, b, and 4a]. Fundus examination of the RE showed a large crescent-shaped hypopigmented area, at the nasal edge of serous PED, suggestive of Grade-4 RPE rip involving the fovea with SRF and the same was confirmed on OCT [Figures 3c and 4b]. A repeat FA of the RE revealed a crescent-shaped window defect across the fovea corresponding to the RPE rip and two extrafoveal active point leaks temporally [Figure 3d].
case_images: Right eye - OCT images: bullous serous PED at the first visit (a); PED with spontaneous RPE rip (edges marked with white arrows) at 6 months (b); at 6-week posttreatment, flattened out PED with patchy islands of reappearing RPE and photoreceptor layer (white arrows) with hypertransmission defects seen in between the islands through foveal and juxtafoveal sections (c and d); at 1-year posttreatment, subfoveal reorganization of the RPE-photoreceptor complex and better continuity of the ELM and ellipsoid zones (white arrows) (e and f). PED: Pigment epithelial detachment, RPE: Retinal pigment epithelium, OCT: Optical coherence tomography, ELM: External limiting membrane
case_images: OJO-16-170-g004.jpg
case_images: PMC10062083_01_OJO-16-170-g004.jpg
case_images: F4
case_images: The RE fundus showed a large serous PED, with FA and OCT confirming the same without any SRF and leakage [Figures 3a, b, and 4a]. Fundus examination of the RE showed a large crescent-shaped hypopigmented area, at the nasal edge of serous PED, suggestive of Grade-4 RPE rip involving the fovea with SRF and the same was confirmed on OCT [Figures 3c and 4b]. Follow-up OCT at 6 weeks showed resolved SRF and a healing pattern of the subfoveal RPE rip with patchy islands of the RPE and photoreceptor (PR) layer reappearing in the subfoveal region with hypertransmission defects seen in between the islands [Figure 4c and d]. OCT of the RE showed normal foveal contour with healing of the subfoveal RPE rip by reorganization of RPE-PR complex and islands of regenerating subfoveal PR layer coalesced giving better continuity of the external limiting membrane and ellipsoid zones with reduced hypertransmission defects in between [Figure 4e and f].