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OPHTHALMIC IMAGE
Year : 2019  |  Volume : 67  |  Issue : 7  |  Page : 1188

Subretinal pigment epithelium cleft: A sign of caution


Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Date of Web Publication25-Jun-2019

Correspondence Address:
Dr. Vedang Shah
Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1851_18

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How to cite this article:
Babu N, Shah V, Kohli P, Shah PK. Subretinal pigment epithelium cleft: A sign of caution. Indian J Ophthalmol 2019;67:1188

How to cite this URL:
Babu N, Shah V, Kohli P, Shah PK. Subretinal pigment epithelium cleft: A sign of caution. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jul 18];67:1188. Available from: http://www.ijo.in/text.asp?2019/67/7/1188/261027



A 42-year-old male presented with history of defective vision in right eye for 7 months. Best-corrected visual acuity was 20/240 in the right eye and 20/30 in the left eye. Right eye fundus showed a retinal pigmental epithelium (RPE) degeneration along with scarring at the macula [Figure 1]a. Fundus fluorescein angiography was suggestive of RPE rip at macula [Figure 1]b. Ocular coherence tomography showed outward bowing of Bruch's membrane, hyper-reflective material attached to the RPE suggestive of a fibrovascular complex and a hypo-reflective space between the Bruch's membrane and the choroidal neovascular (CNV) complex suggestive of a sub-RPE cleft [Figure 1]c.
Figure 1: (a): Fundus photograph showing retinal pigmental epithelium (RPE) degeneration along with scarring at the macula. (b): Fundus fluorescein angiography showing area of hyperfluorescent window defect adjacent to area of blocked fluorescence corresponding to redundant RPE suggestive of RPE tear. (c) Ocular coherence tomography showed outward bowing of Bruch's membrane, hyper-reflective material attached to the RPE suggestive of a fibrovascular complex and a hypo-reflective space between the Bruch's membrane and the choroidal neovascular (CNV) complex suggestive of a sub-RPE cleft

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The fibrovascular complex attached to the RPE and the sub-RPE cleft is associated with high risk of RPE rip and residual activity after treatment with anti-vascular epithelial growth factor injections.[1],[2],[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nagiel A, Freund KB, Spaide RF, Munch IC, Larsen M, Sarraf D. Mechanism of retinal pigment epithelium tear formation following intravitreal anti-vascular endothelial growth factor therapy revealed by spectral-domain optical coherence tomography. Am J Ophthalmol 2013;156:981-8.  Back to cited text no. 1
    
2.
Mukai R, Sato T, Kishi S. A hyporeflective space between hyperreflective materials in pigment epithelial detachment and Bruch's membrane in neovascular age-related macular degeneration. BMC Ophthalmol 2014;14:159.  Back to cited text no. 2
    
3.
Khan S, Engelbert M, Imamura Y, Freund KB. Polypoidal choroidal vasculopathy: Simultaneous indocyanine green angiography and eye-tracked spectral domain optical coherence tomography findings. Retina 2012;32:1057-68.  Back to cited text no. 3
    


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