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Recurrent RPE microrips in a case of vascularised pigment epithelial detachment
G Virgili1, C Salati, P Lanzetta
1Department of Ophthalmology, University of Udine, Italy.
Abstract:
Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.
Insights
Recurrent RPE microrips, linked to vascularised pigment epithelial detachments (PEDs), were observed alongside subretinal hemorrhages. This suggests high protein levels from bleeding may damage the RPE, causing leaks similar to central serous chorioretinopathy (CSC).
Area of Science:
- Ophthalmology
- Retinal Diseases
- Medical Imaging
Background:
- Microrips of the retinal pigment epithelium (RPE) are rare in vascularised pigment epithelial detachments (PEDs).
- Angiographic findings of RPE microrips resemble leaks seen in central serous chorioretinopathy (CSC).
- Hydrostatic forces are hypothesized to cause mechanical disruption of the RPE in both conditions.
Observation:
- A case of vascularised PED with recurrent subretinal hemorrhages and RPE microrips is presented.
- This combination of findings has not been previously documented.
- A high protein concentration in the subretinal space was noted due to prolonged bleeding.
Findings:
- The high protein concentration may have damaged the RPE and reduced choroidal suction, similar to CSC pathogenesis.
- Elevated intraluminal pressure within the PED likely contributed to fluid passage through RPE microrips.
- These microrips are hypothesized to represent defects in the RPE layer.
Implications:
- This case offers new insights into the pathogenesis of RPE microrips and vascularised PEDs.
- The findings support and expand upon hypotheses regarding the mechanisms behind CSC leaks.
- Further research may clarify the unique angiographic patterns observed in CSC and RPE microrips.