Subretinal pigment epithelium cleft: A sign of caution.

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 [Fig. 1a]. Fundus fluorescein angiography was suggestive of RPE rip at macula [Fig. 1b]. 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 [Fig. 1c].

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

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.[123]

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