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Case 8-20, Hemorrhagic Detachment of the Retinal Pigment Epithelium

Clinical Summary

A 65-year-old woman had a hemorrhagic pigment epithelial detachment in her right eye. Slit-lamp examination (A) showed the detachment inferotemporal to the fovea, an additional serous pigment epithelial detachment superotemporal to the macula, and subretinal fluid and cystoid macular edema directly in the fovea. Her visual acuity in this eye was 20/100. Fluorescein angiography (B) revealed a large area of hyperfluorescence consistent with hemorrhage and a hyperfluorescent lesion superoiemporal to the fovea consistent with a serous detachment of the retinal pigment epithelium (RPE). Hyperfluorescence was also observed within and nasal to the fovea.

Optical Coherence Tomography

An OCT image (C) obtained through the hemorrhagic detachment of the RPE showed an elevation of the neurosensory retina. The blood filled cavity was highly reflective towards the surface, but significantly attenuated the reflections returning from deeper within the hemorrhage and choroid. The reflective band corresponding to the RPE was indistinguishable from the anterior margin of the hemorrhage.

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