Repair after tears of the retinal pigment epithelium

Sixty-three eyes (in 59 patients) with tears of detached retinal pigment epithelium have been studied for a period of up to 10 years after the acute event. In the majority of cases a plaque of fibrous tissue was laid down gradually in the bed of the tear. In a few eyes the inner surface of Bruch's membrane appeared to remain relatively unaltered for up to 2 years, and in four eyes it was recovered with pigmented tissue resembling normal retinal pigment epithelium. These and other changes progressively obscured the distinctive feature of the original lesion; the nature of the original lesion was evident at 6 months in all cases, by 1 year it was recognisable in 94 per cent, by 2 years in 77 per cent and by 6 years in none. Choroidal neovascularisation was detected or suspected in one third of cases in the acute stages and developed in others weeks to months after the acute event. Alteration of the morphology occurred more quickly, and there was greater scarring, in those with new vessels or significant blood in the subretinal space, when compared with those without such features. Visual acuity was surprisingly good in many patients immediately after the tear. However, loss of vision accompanied the reactive tissue remodelling, and no case had long term retention of good visual acuity.