Spontaneous RPE tear in high myopia

Purpose
The aim of this study is to present the case of a spontaneous retinal pigment epithelial tear in high myopia

Material and methods
A 56 years old woman with high myopia (refractive error -10.0D) in both eyes and amblyopia in right eye since childhood, complained of a decrease in left eye vision for one and a half month. Full ophthalmic examination, fundus photography, ultrasound examination and indocyanine green angiography were performed.

Results
At first visit BCVA was 5/25 in her left eye. A subretinal hemorrhage accompanied by retinal pigment epithelial tear inferotemporal to the fovea was found in ocular examination. B-scan ultrasound did not revealed any traction at the fovea. 3 months later BCVA was 5/16 OS. The area of the atrophy of RPE – Bruch’s membrane – choriocapillaris complex expanded and hyperpigmentation occured above the RPE tear. 3 months later BCVA was 2/50 OS, we observed a dark brown pigment spot surrounded with a subretinal hemorrhage somewhat above the RPE tear. Indocyanine green angiography demonstrated an initial choroidal neovascularization at superotemporal edge of hypertrophic pigment epithelium (Fuch’s spot).

Conclusions
A spontaneous RPE tear might be the beginning of Fuchs’ spot. A mechanical stress associated with eye movement is transmitted through the thin sclera and Bruch’s membrane onto RPE and may cause a tear in its most vulnerable place i.e. at the margin of posterior staphyloma.