Retinal pigment epithelium aperture: a previously unreported finding in the evolution of pigment epithelium detachment

Abstract

Purpose : To describe retinal pigment epithelium (RPE) aperture and to generate hypotheses about pathogenesis of this previously unreported finding in the evolution of avascular pigment epithelium detachment (PED).

Methods : Medical records and multimodal imaging results from 10 patients with RPE apertures were reviewed between January 2009 and September 2015 to two institutions. Main outcome measures were analysis of RPE apertures imaging characteristics, including apertures area and PED diameters, and their temporal course. Lesions preceding RPE apertures development were also evaluated.

Results : Eleven RPE apertures were identified in 10 eyes of 10 patients (1 male, 9 female; mean age 73.1±6.7 years) and included for analysis. RPE apertures appeared as round discontinuity either at the apex, or at the base of avascular PED. No rippling or retraction of the RPE was found at sites of aperture. RPE apertures enlarged homogeneously (mean round area of hypoautoflurescence significantly increased from 0.18±0.13 to 0.93±1.2; p=0.005), and PED flattened (PED maximal height on spectral-domain optical coherence tomography decreased from 445.2±259.0 to 211.5±217.1; p=0.06) after a mean of 39±16.3 months. Analysis of lesions preceding RPE apertures revealed areas of focal hyperautoflurescence at the site of development, sometimes appearing as drusenoid material connected with the base of avascular PED.

Conclusions : RPE aperture represents a previously unreported possible evolution of avascular PED, which should be distinguished by typical RPE tears. Analysis of lesions preceding RPE apertures suggests focal atrophic progression of drusenoid material in its pathogenesis.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.