case_images: PMC10620019_01
case_images: Findings at the initial presentation of the patient. Color fundus photograph showed slightly paled optic disc and large cupping of optic disc (a). Vertical scan of optical coherence tomography (OCT) showed normal findings without any pigment epithelial detachment (PED) and choroidal neovascularization (b). OCT imaging of the circumpapillary retinal nerve fiber layer (cpRNFL) deviation map in the right eye showing thinning of the cpRNFL on both the superior and inferior sides (c). Fluorescein angiography showed partial delayed filling in the optic disc at superior and nasal side (arrowhead) (d) and delayed filling of the choroidal perfusion around the nasal-inferior region, including near the optic disc (arrow) (e). A Humphrey visual field test performed at our hospital one month after the initial visit revealed a severe visual field defect (g) that was much worse than the result observed at the previous hospital nine months earlier (f).
case_images: CRIOPM2023-6645156.001.jpg
case_images: PMC10620019_01_CRIOPM2023-6645156.001.jpg
case_images: fig1
case_images: No signs of papilledema were observed (Figure 1(a)). Optical coherence tomography (OCT) showed no retinal pigment epithelial detachment (PED) or choroidal neovascularization in the macula (Figure 1(b)), but there was scattered drusen in the peripheral retina. OCT imaging of the circumpapillary retinal nerve fiber layer (cpRNFL) deviation map demonstrated thinning of the cpRNFL on both the superior and inferior sides (Figure 1(c)). Fluorescein angiography (FAG) showed partial delayed filling in the optic disc at superior and nasal sides and delayed filling of the choroidal perfusion around the nasal-inferior region, including near the optic disc (Figures 1(d) and 1(e)). Visual field testing was performed using a Humphrey visual field analyzer which showed a significant worsening during recent 9 months (Figures 1(f) and 1(g)).
case_images: Findings at the onset of RPE tears on postoperative day 13. Color fundus photograph revealed RPE tears along the superior arcade vessel (arrowhead) (a). Fluorescein angiography (FAG) showed window defects corresponding to the site of RPE tears (b). Wide-field fundus photograph showed bullous macula off retinal detachment inferiorly (arrowhead) (c). Wide-field FAG revealed window defects corresponding to the site of RPE tears extending from near the optic nerve disc to the superior-temporal peripheral area (d).
case_images: CRIOPM2023-6645156.002.jpg
case_images: PMC10620019_01_CRIOPM2023-6645156.002.jpg
case_images: fig2
case_images: Fundus examination revealed an RPE tear along the superior arcade vessel, extending from the optic nerve disc to the superior-temporal peripheral area, as well as bullous retinal detachment extending from the posterior pole to the inferior peripheral retina (Figures 2(a) and 2(b)). FAG demonstrated hyperfluorescence corresponding to the RPE tears (Figures 2(c) and 2(d)).
case_images: Wide-field fundus photograph and optical coherence tomography (OCT) imaging 12 months after Ex-PRESS filtration surgery. Fundus photograph showed that although retinal detachment almost recovered, widened RPE tears and subretinal proliferative tissue remained superior to the posterior pole (arrowhead) (a). OCT imaging corresponding to the line in the fundus photograph revealed an RPE defect (arrow) and partial traction of the retina due to subretinal proliferative tissue (asterisk) (b). Fundus autofluorescence (FAF) showed hypofluorescence corresponding to the area of RPE tears (c).
case_images: CRIOPM2023-6645156.003.jpg
case_images: PMC10620019_01_CRIOPM2023-6645156.003.jpg
case_images: fig3
case_images: However, the RPE tear persisted, and tractional retinal folds caused by subretinal proliferative tissue were observed (Figures 3(a)-3(c)).