Case 8-19, Hemorrhagic Detachment of the Retinal Pigment Epithelium

Clinical Summary

A 78-year-old man with age-related macular degeneration noted decreased vision in his right eye over a period of two months. On examination, his vision was assessed at 20/80. Slit-lamp biomicroscopy (A) showed a centra] hemorrhagic pigment epithelial detachment with surrounding subretinal fluid. A hypofluorescent lesion on fluorescein angiography (B) confirmed the hemorrhage, and late leakage was noted superior to the fovea. Indocy-anine green angiography (not shown) revealed a focal area of hyperfluorescence nasal to the pigment epithelial detachment which was suspicious for choroidal neovascularization.

Optical Coherence Tomography

An OCT image (C) acquired horizontally showed an elevation of both the neurosensory retina and a red band corresponding to the retinal pigment epithelium- The red band appeared thinner in the region of the detachment than in the surrounding retina, where it was indistinguishable from the reflection from the choriocapillaris. Small pockets of minimal reflectivity were noted adjacent to the detachment corresponding to the subretinal fluid observed clinically The reflections from the pigment epithelium and choriocapillaris appeared thicker in the nasal compared to the temporal aspect of the image, consistent with the putative region of choroidal neovascularization. Moderate backscatter which attenuated quickly with depth was observed beneath the detached RPE consistent with hemorrhage.

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