The pretear characteristics of pigment epithelial detachments. A study of 40 eyes
G. Coscas, F. Koenig and G. Soubrane
Department of Ophthalmology, University of Creteil, France.
Retinal pigment epithelial tears are a major complication of pigment
epithelial detachment (PED) in the elderly. We observed the pretear process
of PED in 38 patients (40 eyes) to identify characteristic angiographic
changes. Before the tear occurred, the filling pattern of the PED underwent
alterations, including an increase in the size and a modification in the
shape of the PED (27 eyes); the development of notches (14 eyes); and the
onset or increase of subretinal fluid, hard exudates, and/or hemorrhages
(30 eyes). The most noteworthy feature was the uneven filling of the PED,
with a remarkably hypofluorescent central area that remained dark until the
late angiographic frames (24 eyes). Conversely, hyperfluorescence appeared
early at the margins of the PED, increased progressively, and sometimes
demonstrated a crenated edge. The high risk of tearing indicates that laser
treatment of the retina should be considered carefully in the presence of
these angiographic features.
