'Blow-outs' in the retinal pigment epithelium.

Abstract

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,

Spontaneous closure of retinal pigment epithelium microrip in the natural course of central serous chorioretinopathy

“…15 It has been postulated in the past that mechanical stress in CSC may cause RPE to give way at some point, which is observed as a point of leak on fluorescein angiography. 4,6 The breach will allow the passage of fluid, including particulate matter, into the subretinal space from the underlying hyperemic choroid. This would also mean that the resolution of subretinal fluid could result from decreased effusion from choroid, accompanied by a healing of the RPE microrip.…”

“…Further, a microrip or 'blow-out' in this PED has been postulated to result in a focal leak, which is observed as the point of leak on fluorescein angiogram. [4][5][6] Recently, a RPE defect within the PED at the leakage site has been reported on both time-domain 7 and fourier-domain OCT. 8 Fujimoto et al 8 observed RPE abnormalities at the site of leakage in 96% of eyes, with 22% of the eyes showing an RPE defect that was successfully treated with thermal laser photocoagulation. However, the natural course of these RPE abnormalities observed in the acute phase of CSC is not known.…”

Unintentional secondary exogenous corticosteroid exposure and central serous chorioretinopathy

“…The choroid is thickened, and the resultant increase in choroidal hydrostatic pressure is thought to perhaps overwhelm the RPE and result in the accumulation of SRF and PEDs. 3,5,6 The pathophysiologic role of corticosteroids in the exacerbation of CSCR may be via their action on the RPE, Bruch's membrane, or the choroid, but the exact mechanism remains unclear and requires further study. 2,[7][8][9] There are multiple reports describing the association between exogenous corticosteroid and CSCR.…”

Tears of The Retinal Pigment Epithelium – A Review

“…62 Goldstein and Pavan noted "blowouts of the RPE" at the dome of the PED without any retraction or rolling of the torn RPE layer. 28 In one case the site which showed tremendous leakage of dye into the subretinal space on FFA, was later noted to develop a RPE defect. Hence, they suggested that the intense leakage across the RPE in CSC can lead to weakening and eventual disintegration of these cells, causing 'RPE blow-out'.…”

“…Rpe Tears In Central Serous Chorioretinopathy -"Blow-outs of the RPE" Goldstien and Pavan 28 described two patients with defects in the RPE underlying a neurosensory elevation. Both their cases occurred in middle aged men in the setting of severe CSC.…”