'Blow-outs ' in the retinal pigment epithelium

SUMMARY A hole was detected in the epithelium of a retinal pigment epithelium (RPE) detachment in two patients. Leakage through the hole led to an elevation of the overlying neurosensory retina in each case. The resulting vision was 20/70 in one eye and 20/30 in the other. The defects in the RPE occurred in a setting different from that usually seen with tears in the pigment epithelium and had a different clinical appearance. Two patients were seen who had a defect in the epithelium of a retinal pigment epithelium (RPE) detachment underlying a neurosensory retinal elevation. These defects were confirmed by stereo-biomicroscopy and stereophotography. They were not similar to the RPE rips or tears which have been previously described.'" ' Fluorescein angiography demonstrated intense leakage through the defects in each case. In one patient the evolution of the defect suggested that build-up of fluid pressure in the RPE detachment led to a 'blow-out', causing the defect and subsequent intense leakage with its overlying' neurosensory detachment. We believe our patients had a variant of central serous choroidopathy, and the observations made here on the aetiology of the Correspondence to Peter Reed Pavan, MD, USF Medical Clinics