Retinal Pigment Epithelial Tear in Polypoidal Choroidal Vasculopathy

In Brief Purpose: To study the clinical characteristics of tears of the retinal pigment epithelium (RPE) in eyes with polypoidal choroidal vasculopathy (PCV). Methods: The authors report eight eyes of eight patients with PCV that had tears of the RPE. These were examined with angiography and tomography. Results: Eight eyes of eight patients (seven men and one woman) had RPE tears at the margin of a serosanguineous pigment epithelial detachment (PED) associated with PCV. Tears of the RPE were detected at the initial visit in one eye and during follow-up without any treatment in five eyes. In two eyes, the RPE tears were detected 3 months and 6 months, respectively, after photodynamic therapy. In all eyes, the RPE tears were detected at the side opposite to the polypoidal lesions of the PEDs, and the fovea was not involved in the RPE tear. Visual acuity in the seven eyes without RPE tears on presentation ranged from 20/100 to 20/16 (median, 20/32). During follow-up, three of these eyes lost three or more lines of vision. At the final examination, while three of these eyes had visual acuity of 20/25 or better, the other four had visual acuity of 20/200 or worse. Conclusion: In eyes with PCV, RPE tears can occur at the margin of serosanguineous PEDs—either spontaneously or after photodynamic therapy. In eyes with polypoidal choroidal vasculopathy, tears of the retinal pigment epithelium were seen at the margin of the serosanguineous pigment epithelial detachment, spontaneously without any treatment in 6 eyes of our patients and following photodynamic therapy in the other 2 eyes. In none of these eyes was the fovea involved in the RPE tear.