Spontaneous bilateral retinal pigment epithelium rips with good visual acuity

Retinalpigment epithelium (RPE) rips commonly occur in retinochoroidal disorders including age-related macular degeneration, idiopathic polypoid alchoroidal vasculopathy, central serous chorioretinopathy, high myopia andchoroidal neovascularization. Most patients have unilateral involvement and poor visual prognosis. A 55-year-old female presented with decreased vision in her right eye for one week. Her best-corrected visual acuity was 6/12 in the right eye and 6/6-2 in the left. Fundus examination revealed a large juxtafoveal RPE rip in the right eye and multiple small pigment epithelium detachments in the left. No abnormal hyperfluorescent lesions were detected byfundus angiography. High-doseoral antioxidant was prescribed. A pigment epithelium detachment (PED) in the left eye grew larger over the follow-up period. Ultimately, a RPE rip also occurred in the left eye in the 17th week offollow-up. Her best-corrected visual acuity was 6/9. Although reinvestigation was done, no other choroidal abnormalities were demonstrated by optical coherence tomography (OCT) and fundus angiography. During the observation, RPE tears were reattached spontaneously in both eyes. A considerable amount of RPE proliferation, migration, and repopulation was also demonstrated by OCT and fundus autofluorescence. After 2.5 years of follow-ups, her best-corrected visual acuity was 6/9 in the right eye and 6/6 in the left. We hypothesize that the increased surface tension of RPE is the etiology of RPE rips in this case. Furthermore, the underlying chorioretinal abnormality directly affects the visual prognosis and further studies are needed in prevention, pathogenesis and treatment.