A curious case of sequential giant retinal pigment epithelium rip

Retinal pigment epithelium (RPE) rips are not uncommon in the setting of underlying choroidal pathologies, including central serous chorioretinopathy, choroidal neovascular membrane, polypoidal choroidal vasculopathy, and trauma. Most cases present with sudden effusion of choroidal fluid into the subretinal space, resulting in a sudden decrease in the vision. We encountered a case of acute exudative retinal detachment in an elderly patient secondary to RPE rip. Extensive imaging revealed no underlying risk factors for the rip. Surgical drainage of the subretinal fluid resulted in further extension of the rip with subsequent fluid resolution and reattachment of retina. After a gap of 16 months, second rip occurred in the nasal quadrant. This case highlights the unpredictable course of RPE rips and the risk factors associated with their enlargement during surgical maneuvers.