Tear of the Retinal Pigment Epithelium After Brachytherapy of Choroidal Melanoma

Retinal pigment epithelial tear and extensive exudative retinal detachment following blunt trauma

“…Therefore, in this case the direct blow, which was sufficient to tear the RPE but not Bruch's membrane and choroid, could have induced the peripheral RPE tear. Ordinarily, RPE tears are seen in eyes with RPE or choroidal abnormalities [1, 4, 5, 9-11, 13, 18, 21-23]; when the RPE is weak or stretched, an RPE tear sometimes occurs spontaneously [4] or after mechanical stress [4,21]. In our case, the patient had retinochoroidal folds.…”

“…In RPE tears reported in patients with AMD, although the RPE barrier was destroyed by the tear, minimal or no choroidal leakage was observed [4,9,18], probably because the choriocapillaris became atrophic in the macula during the natural course of the disease [4]. Further, extensive choroidal leakage did not occur in cases with an RPE tear with acute retinal necrosis [5], and after radiation of a choroidal tumor [21] and panretinal photocoagulation [13], probably because the choriocapillaris was atrophic. Therefore, atrophy of the choriocapillaris may result in minimal or no retinal detachment after an RPE tear.…”

“…On the other hand, midperipheral and peripheral RPE tears are rare and tend to be much larger [1,5,10,11,13,[21][22][23]. RPE tears outside the macula have occurred in patients with a rhegmatogenous retinal detachment [23], choroidal tumor [21], chorioretinal scar [23], RPE detachment with central serous chorioretinopathy [22], acute retinal necrosis [5], panuveitis [1], and after glaucoma surgery with or without photocoagulation [11,13].…”