Tears of detached retinal pigment epithelium.

Ripping of detached pigment epithelium appears to be a common sight-threatening complication of pigment epithelial detachments and occurs at the junction of the detachment and flat pigment epithelium. The characteristics of the detachment prior to the rip suggest that the tear occurs in pigment epithelium which is detached without its basement membrane. The tear is followed by retraction of the pigment epithelium, revealing bare Bruch's membrane. The defect may remain apparently unaltered, or may be recovered by normal looking pigment epithelium, but most commonly is replaced by a fibrous plaque. Most patients had a profound reduction in visual acuity.