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SUMMARY 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 stereobiomicroscopy 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 Peter Reed Pavan, MD,

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