Idiopathic multiple tiny serous retinal pigment epithelial detachments: Report of 2 cases and review of the literature

MULTIMODAL IMAGING OF BILATERAL IDIOPATHIC MULTIFOCAL RETINAL PIGMENT EPITHELIAL DETACHMENTS IN YOUNG PATIENTS

PURPOSE

The aim of this study was to describe two cases of multiple epithelial detachments (pigment epithelial detachments [PEDs]) occurring in otherwise young, healthy patients.

METHODS

The medical and imaging records of two cases were reviewed retrospectively.

RESULTS

Multiple serous nonvascularized PEDs were present in two young, healthy patients who underwent multimodal imaging. The first patient, a 38-year-old woman, was incidentally found to have a visual acuity of 20/20 in both eyes and multiple bilateral PEDs. Imaging and a systemic work-up was negative for secondary causes, and at 36 months, vision remained stable although some of the PEDs had coalesced. The second patient, a 32-year-old woman, presented with distortion and perceived scotomas in both eyes progressive over the course of 2 years. The visual acuity was 20/20, and multimodal imaging confirmed the presence of bilateral PEDs.

CONCLUSION

Bilateral idiopathic multifocal retinal PEDs in otherwise healthy young adults is a rare condition. Longer term follow-up is needed to evaluate secondary complications and visual outcomes.

Bilateral multiple blisters of retinal pigment epithelium in a healthy young female

BACKGROUND/ PURPOSE

Multiple serous pigment epithelium detachments (PEDs) have been infrequently reported. We report a case of a young female with bilateral innumerable serosanguinous PEDs, giving an appearance of multiple blisters.

METHODS

A 26-year-old female presented with sudden onset diminution of vision in left eye. She had bilateral innumerable translucent blister-like elevations of retinal pigment epithelium (RPE) and a few hemorrhagic blister-like elevations at macula and submacular blood in left eye. Multi-modal fundus imaging was performed. Pneumatic displacement and intravitreal injection of ranibizumab was performed in left eye.

RESULTS

optical coherence tomography (OCT) confirmed multiple serous PEDs with pachychoroid morphology in both eyes and few hemorrhagic PEDs at the macula in left eye. The lesions were hypoautofluorescent with a halo of hyperautofluorescence. Fluorescein angiography revealed pooling into the serous PEDs in both eyes and few late leakage points in the area of blocked fluorescence at the macula in left eye. One-month following the intervention, subretinal blood had partially displaced with modest visual acuity gain. However, the patient refused further intravitreal injections.

CONCLUSION

Bilateral extensive serous PEDs, to the extent noted in this case, have not been previously reported. A widespread RPE-Bruch's membrane defect is suspected.

Symptomatic idiopathic bilateral multifocal retinal pigment epithelial detachments

Purpose

To report a rare case of idiopathic bilateral serous retinal pigment epithelial detachments.

Observations

We present a case of a 43-year-old female patient with metamorphopsia with the presence of innumerable bilateral serous retinal pigment epithelial detachments. Detailed ocular and systemic clinical work-up revealed no underlying disease.

Conclusions

/Importance: Idiopathic multiple serous retinal pigment epithelial detachments are an extremely rare condition, that has been observed as an incidental clinical finding in asymptomatic patients. Multimodal imaging and detailed systemic work up are essential to rule out an underlying disease. Initial symptoms, as in our case, are uncommon and usually occur only in patients with complications such as choroidal neovascularization or hemorrhages. Therefore, regular follow ups are recommended to early detect and treat possible complications.

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Idiopathic multiple serous retinal pigment epithelial detachments (PEDs) are an extremely rare condition.

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Multimodal imaging is essential to confirm the serous nature of the PEDs and to rule out presence of an underlying disease.

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Regular follow ups are recommended to early detect and treat possible complications.

Idiopathic multiple retinal pigment epithelial detachments - A case report

Retinal pigment epithelial detachment, often asymptomatic is a common retinal finding. Multiple serous retinal pigment epithelial detachment especially in a female is very uncommon. We describe a case of multiple retinal pigment epithelial detachments throughout the fundus in a 51-year old female otherwise asymptomatic. Indocyanine green angiography and fundus auto fluorescence showed abnormalities with a normal systemic work-up. This is the first report of an asymptomatic patient correlating angiogram with auto fluorescence in multiple serous retinal pigment epithelial detachments.

Pachychoroid pigment epitheliopathy

PURPOSE

To report nine cases of pachychoroid pigment epitheliopathy.

METHODS

An observational case series of nine patients who underwent comprehensive ophthalmic examination, fundus photography, fundus autofluorescence, spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography.

RESULTS

Eighteen eyes of 9 patients, aged 27 years to 89 years, were diagnosed with pachychoroid pigment epitheliopathy based on the characteristic funduscopic appearance of reduced fundus tessellation with overlying retinal pigment epithelial changes in one or both eyes, fundus autofluorescence abnormalities, and increased subfoveal choroidal thickness confirmed by enhanced depth imaging optical coherence tomography (mean, 460.2 μm). The five older patients had been previously diagnosed with age-related macular degeneration, while the four younger subjects were referred for possible inflammatory chorioretinitis, pattern dystrophy, or nonspecific drusen. No subjects had a history of or subsequently developed subretinal fluid.

CONCLUSION

Pachychoroid pigment epitheliopathy falls within a spectrum of diseases associated with choroidal thickening that includes central serous chorioretinopathy and polypoidal choroidal vasculopathy, and it should be suspected in eyes with a characteristic fundus appearance related to choroidal thickening and associated retinal pigment epithelial abnormalities but no history of subretinal fluid. Enhanced depth imaging optical coherence tomography confirming an abnormally thick choroid and characteristic retinal pigment epithelial changes on fundus autofluorescence support the diagnosis. Because these patients are frequently misdiagnosed, the recognition of pachychoroid pigment epitheliopathy may avoid unnecessary diagnostic testing and interventions.