Recovery of retinal pigment epithelium correlating with restoration of retinal sensitivity in eyes with a retinal pigment epithelial tear

Abstract

Report of Cases. A 63-year-old man presented with visual acuity (VA) of 20 ⁄ 200 in the right eye. The patient had undergone photodynamic therapy (PDT) combined with sub-Tenon's triamcinolone acetonide three times to treat neovascular age-related macular degeneration (AMD) in the right eye. Four months after the last PDT application, fluorescein and indocyanine green angiography (FA ⁄ IA) (HRA2, Heidelberg Engineering, Heidelberg, Germany) showed active occult choroidal neovascularization (CNV) and a large, dome-shaped PED on SD-OCT (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA) (Fig. 1). One month later, a retinal pigment epithelial (RPE) tear occurred (Fig. 1). The Fundus autofluorescence (FAF) image on HRA2 showed hypoautofluorescence corresponding to the RPE defect with autofluorescent lipofuscin granules, while hyperautofluorescence was seen in the curled RPE layer (Fig. 2). Interestingly, the hypoautofluorescent area reflecting the denuded lesion secondary to the RPE tear gradually decreased, suggesting that the RPE might regenerate and ⁄ or migrate from the border of the RPE tear. Microperimetry on MP-1 (Nidek Technologies, Padova, Italy) showed no recordable retinal sensitivity in the area without an RPE layer. Also, the visual acuity remained poor (20 ⁄ 500) at final visit. However, the retinal sensitivity gradually improved with repopulation of the RPE rather than reattachment of the RPE layer (Figs 1 and 2).An 83-year-old man presented with decreased VA of 20 ⁄ 30 in the left eye. Retinal examination showed a domeshaped PED involving the macula (Fig. 3). IA showed hypofluorescence in the area with the PED and hyperfluorescence from CNV at the edge of the PED (Fig. 3). Three months later, the VA decreased to 20 ⁄ 100 because of a RPE tear. OCT showed a PED with focal disruption of the RPE layer (Fig. 3). FA showed hyperfluorescence in the area with the RPE defect (considered a window defect) and hypofluorescence in the area with the retracted RPE layer. FAF showed a large hypoautofluorescent area associated with no RPE layer (Fig. 4). However, 3 months after the RPE tear, the macular detachment resolved on OCT (Fig. 3). FA (Fig. 3) and FAF (Fig. 4) showed that the area without an RPE layer gradually decreased with recovery of the RPE. The FAF images showed RPE layer regrowth despite a subretinal haemorrhage 4 months after the RPE tear (Fig. 4). However, the visual acuity remained poor (20 ⁄ 500) at final visit.Comment. A RPE tear is a serious complication in eyes with serous pigment epithelial detachment (PED) in neovascular AMD. Consistent with previous report (Chan et al. 2010), there were substantial PED heights prior to the development of RPE tears in both of our cases.Using fundus photograph, FA ⁄ IA, SD-OCT and FAF, we studied two cases with repopulation of the RPE layer and also the recovery of retinal sensitivity onto the denuded area after a RPE tear secondary to neovascular AMD.We cannot rule out the recovery of hyperautofluorescence to be partially related to the presence of fluorophores o...

Atypical Healing in a Case With Retinal Pigment Epithelium Apertures

“…13 By contrast, cases of resolution of the RPE defect have been also described. [7][8][9][10] Zahid et al, 7 reported a case with complete restoration of the hyperreflective RPE band on OCT and partial normalization of the FAF signal in the three distinct areas of RPE tear. Based on clinical and multimodal imaging observations, three different healing mechanisms have been proposed: RPE repopulation, RPE migration, and RPE hyperplasia, 8 although the exact mechanism of this RPE restoration processes remains unknown.…”

“…Also, areas of RPE aperture tend to extend over time, 1 whereas tears tend to be stable, although cases of restoration of the RPE defect have been described. 7–10…”

Prediction of retinal pigment epithelial tear in serous vascularized pigment epithelium detachment

“…Retinal pigment epithelium cells appear to be able to recover to some extent at the margin of tear areas partly restoring photoreceptor functionality (Caramoy et al. 2012; Hirano et al. 2012).…”

“…In the light of a constantly growing number of intravitreal anti-VEGF injections in AMD patients, clinicians increasingly face the complication of RPE tear development after intravitreal injections. Retinal pigment epithelium cells appear to be able to recover to some extent at the margin of tear areas Prediction of retinal pigment epithelial tear in serous vascularized pigment epithelium detachment partly restoring photoreceptor functionality (Caramoy et al 2012;Hirano et al 2012). Nevertheless, visual outcomes after RPE tear development remain poor (Gutfleisch et al 2011).…”

Retinal Pigment Epithelium Tear

“…Several studies utilizing auto-fluorescence and OCT have shown evidence of RPE proliferation, migration and repopulation [39,41]. However, the viability of the migrated RPE is not clear [42]. In fact, intraretinal RPE migration was noted in addition to RPE migration located directly on Bruch's membrane.…”