Bilateral Giant Pigment Epithelial Detachments and Unilateral RPE Tear and Exudative Retinal Detachment After Tadalafil Exposure: Case Report and Review of the Literature

To describe a case of bilateral giant pigment epithelial detachments (PEDs) complicated by unilateral giant retinal pigment epithelium (RPE) tear and macula-off exudative retinal detachment (RD) in the context of tadalafil exposure, and to place it in the spectrum of reported non-AMD giant RPE tears.

Case report with multimodal imaging and comprehensive systemic work-up, combined with a focused literature review of exudative RD associated with giant RPE tears unrelated to age-related macular degeneration.

A 62-year-old man presented with blurred vision in the left eye. Examination revealed bilateral giant temporal PEDs and, in the left eye, a crescent-shaped giant RPE tear contiguous with an inferior macula-off exudative RD and bilateral pachychoroid on OCT. Extensive systemic and ocular investigations were unremarkable except for regular tadalafil use. Discontinuation of tadalafil led to rapid resolution of subretinal fluid and improvement of BCVA to 20/25 OS at one year, whereas re-exposure triggered recurrence of serous macular detachment. Using the Naranjo scale, the causal relationship between tadalafil and the ocular event was rated as "certain". Literature review identified 33 published patients (43 eyes) with exudative RD and giant RPE tears without AMD, most commonly associated with bullous CSC and other pachychoroid entities.

Bilateral giant PEDs with unilateral giant RPE tear and macula-off exudative RD can occur in the setting of tadalafil-associated bullous CSC. This case underscores the importance of systematically reviewing systemic medications, including phosphodiesterase-5 inhibitors, in patients with atypical serous retinal detachments and RPE tears.