Concentric retinal pigment epithelium tear in central serous chorioretinopathy

Abstract

A 24-year-old male patient with chronic central serous chorioretinopathy (CSCR) was evaluated. There was no history of steroid intake or smoking. Blood pressure of the patient was 128/82mm of Hg. Anterior segment was normal OU. Dilated fundus examination of OD revealed serous pigment epithelial detachments (PED, arrows Fig. 1a), which were confirmed using short-wave autofluorescence (SWAF, Fig. 1c), spectral domain optical coherence tomography (SD-OCT, Fig. 2a), and combined fluorescein angiography (FFA) and indocyanine green angiography (ICGA, Fig. 3a, b). The OS showed a hypopigmented area in the inferotemporal macula [Fig. 1b], which was seen as an area of concentric hypoautofluorescence with a central island of normal autofluorescence on SWAF [Fig. 1d]. SD-OCT through the area showed curled retinal pigment epithelium (RPE) at each edge and a central scrolled up RPE [Fig. 2b]. Combined FFA and ICGA revealed window defect with leakage in the late phase [Fig. 4a and b]. OU showed choroidal hyperpermeability on ICGA in late phases. A diagnosis of chronic CSCR OU and concentric RPE tear in OS was made. Figure 1 Fundus photograph (a) OD showing serous pigment epithelium detachments (shown by blue arrow), (b) OS showing hypopigmented area in inferotemporal macula. Short wave autofluorescence (SWAF) (c) OD showing area of hyperautofluorescence corresponding to the area of PED (shown by blue arrow) and (d) OS showing concentric area of hypoautofluorescence with central island of normofluorescence corresponding to RPE tear with central scroll of RPE Figure 2 SD-OCT (a) OD - Pigment epithelial detachments (shown by blue arrow) (b) OS - curled RPE at each edge (shown by blue arrow) and central scrolled up RPE (shown by blue arrow head) Figure 3 Combined FFA and ICGA – OD (a) Early hypo fluorescence (shown by blue arrow) with (b) pooling in late phase (FFA) corresponding to the area of PED (shown by blue arrow). Patches of marked choroidal hyperpermeability on ICGA in late phase (shown by blue arrow head) Figure 4 Combined FFA and ICGA – O (a) Concentric window defect in early phase (b) leakage by in late phase corresponding to area of RPE tear (shown blue arrow head) Discussion Concentric RPE tears are seen in bullous variant of CSCR and are relatively uncommon as compared to crescent-shaped RPE tears that are commonly known to occur in neovascular age-related macular degeneration. The RPE tears in CSCR occur due to contractile forces exerted by the sub-RPE fibrin or increased hydrostatic forces inside a PED.[1] These have thus been named as RPE blowouts previously.[2] Balaratnasingam recently coined the term RPE avulsion for these concentric RPE tears.[1] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.