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Macular Degeneration

Case 8-14, Spontaneous Tear of the Retinal Pigment Epithelium

Clinical Summary

A 69-year-old woman with age-related macular degeneration was evaluated for a decline in the visual acuity of her left eve to 20/200. Fundus examination (A) showed a pigment epithelial detachment with an RPE tear creating an area oi retinal pigment epithelial loss along the inferotemporal border Fluorescein angiography (B) displayed hypo fluorescence superonasallv and interotempo-

rallv with a well-defined demarcation between these two

■if areas. Increased visualization of the choroidal vasculature and late staining was visible in the inferotemporal region of hyper fluorescence consistent with an absence of the pigment epithelium. The superonasal region of hypo fluorescence exhibited a reticular pattern which increased in size and intensity as the angiogram progressed consistent with choroidal neovascularization.

Optical Coherence Tomography

The OCT image (C) exhibited a well-defined elevation of the neurosensory retina and pigment epithelium which shadowed the reflections from the choroid below. Two red reflective layers were visible below the sensory retina in the area of the detachment consistent with a folded, double-layer of pigment epithelium. The choroidal neovascularization below the detachment was not visible due to the lack of optical penetration, A non-reflective region of subretinal fluid was evident superotemporal to the detachment in the image. Enhanced reflectivity and optical penetration of the choroid was noted in this region consistent with the lack of retinal pigment epithelium.

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