Asymmetric Visual Outcomes in Bilateral Non-Neovascular Serous Pigment Epithelial Detachments: Case Report

Purpose: We report a unique case of bilateral non-neovascular serous pigment epithelial detachments (nnSPEDs) in a single patient that resolved through two different mechanisms-an extrafoveal retinal pigment epithelium (RPE) tear and spontaneous collapse-resulting in asymmetric visual outcomes.Case summary: A 78-year-old male was followed for bilateral nnSPEDs.The right eye developed an RPE tear outside the fovea, which led to the resolution of the nnSPED and a visual acuity improvement from 20/30 to 20/25.In contrast, the left eye underwent spontaneous collapse of the nnSPED without an RPE tear, resulting in a decrease in visual acuity from 20/30 to 20/70 and associated photoreceptor damage.Conclusions: This case demonstrates that the resolution of an nnSPED via a timely, extrafoveal RPE tear can lead to a favorable functional outcome by draining sub-RPE fluid before irreversible photoreceptor damage occurs.In contrast, spontaneous collapse may represent a late-stage event following significant RPE and photoreceptor injury.The mechanism, timing, and location of nnSPED resolution are critical in determining the final visual prognosis.