Retinal pigment epithelial detachment associated with retinal pigment epithelium thinning revealed by optical coherence tomography

To clarify the characteristics and outcomes of unusual retinal pigment epithelial detachments (PEDs). These PEDs had one or several sites of apparent thinning of the RPE, or no RPE at all, as shown on optical coherence tomography (OCT). Eight cases with PEDs showed apparent thinning of the RPE in the roof of the PED at one or more sites on OCT. Color fundus photographs, fundus examination records, fluorescein angiograms (FAs) and/or indocyanine green angiograms (ICGAs), obtained with simultaneous OCT using Spectralis(A (R)), and fundus autofluorescence were evaluated. Macular findings, prior to baseline PED detection, were investigated in three cases. Follow-up results were also reviewed in three cases. Well-delineated grayish-white lesions at the level of the choroid observed through a hypo- or unpigmented area corresponding to the area of thinning in the RPE on OCT. These lesions showed intense hyperfluorescence due to staining on both FAs and ICGAs as well as hypofluorescence on fundus autofluorescence. In three eyes, smaller PEDs had been observed at the same locations and were thus taken as the baseline PEDs on images obtained 22-94 months before this study. In two of the three eyes followed up for at least 35 months from baseline, the PEDs collapsed, leaving RPE-choriocapillaris atrophy in one eye and RPE tear in the other. Lesions corresponding to the area of thinning in the RPE on OCT may indicate hypo- or unpigmented RPE, possibly as a result of focal damage due to longstanding PEDs. These PEDs may lead to unexpected complications during long-term follow-up.