Título / Title

A rare case of giant retinal pigment epithelium tear associated with exudative retinal detachment

Introdução / Purpose

To report a rare case of spontaneous giant retinal pigment epithelium tear associated with exudative retinal detachment

Material e Método / Methods

53 year old diabetic male presented with sudden onset decrease vision in left eye of 1 week duration.
Anterior segment examination was normal. Patient had undergone cataract surgery 6 months ago with good visual recovery. Pre operative OCT was normal. Examination of the posterior segment showed exudative retinal detachment with macula off . Pigmented lesion in the inferotemporal periphery was noted amidst the exudative retinal detachement . Moderate NPDR changes were noted in both eyes. Patient underwent OCT, B Scan, FFA and MRI orbit to rule out any masquerading lesion in view of the pigmented mass in the background of the retina

Resultados / Results

Visual acuity was counting fingers at presentation which improved with course of treatment to 6/6 on final follow up. Systemic investigations were negative except for raised ESR. Tests for paraproteinemias were negative. Exudative retinal detachement got better with trial of intravenous steroids and detailed OCT was possible which showed the break in the RPE . FFA initially showed diffuse leak of Exudative RD on repeat angiography showed bare RPE and blocked hypopflourescence of curled RPE . There was no double circulation pattern in FFA.
Retinal pigment epithelial tears occur in patients with age related macular degeneration and following intravitreal injections. Pigment epithelial detachment which are tense, give away causing massive sub retinal haemorrhage

Discussão e Conclusões / Conclusion

Spontaneous large rupture of retinal pigment epithelium with exudative retinal detachment is rarely described. Heaped and curled ripped RPE can masquerade as pigmented lesion like melanoma. Fundus flouroscein angiography clinches the diagnosis. Response to oral steroid/ intravenous steroids has not been described, as in our case. Prompt diagnosis and management can avoid unnecessary investigations.

Palavras Chave

Spontaneous RPE tear Exudative retinal detachment