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 Table of Contents  
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 583-584

Multiple pigment epithelium detachment and ischemic optic neuropathy

1 Department of Vitreo-Retina, Gomabai netralaya, Neemach, Madhya Pradesh, India
2 Department of Vitreo-Retina, B. W. Lions Superspeciality Eye Hospital, Bangalore, Karnataka, India
3 Department of Ophthalmology, All India Institute of Medical Sciences, Guntur, Andhra Pradesh, India
4 Department of Ophthalmology, Gomabai Netralaya, Neemach, Madhya Pradesh, India

Date of Submission18-Oct-2021
Date of Acceptance25-Nov-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
C K Nagesha
Consultant, Department of Vitreo-Retina, B. W. Lions Superspeciality Eye Hospital, Bangalore - 560 002, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2561_21

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Keywords: Crowded disc, ischemic optic neuropathy, optic atrophy, pigment epithelium detachment

How to cite this article:
Hirawat RS, Nagesha C K, Ganne P, Panday G. Multiple pigment epithelium detachment and ischemic optic neuropathy. Indian J Ophthalmol Case Rep 2022;2:583-4

How to cite this URL:
Hirawat RS, Nagesha C K, Ganne P, Panday G. Multiple pigment epithelium detachment and ischemic optic neuropathy. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2023 Jun 9];2:583-4. Available from: https://www.ijoreports.in/text.asp?2022/2/2/583/342965

A 60-year-old woman presented with complaints of diminished vision in the left eye for 8 months. She was hypertensive for 15 years on oral telmisartan. Best-corrected visual acuity in the right eye (OD) was 6/12, N6 and left eye (OS) was 6/60, N18. Anterior segment examination showed nuclear sclerosis grade 2 in both eyes and quiet anterior chamber. Intraocular pressure was 14mm Hg (OD) and 16mm Hg (OS). Fundus showed multiple retinal pigment epithelium detachments (PED) scattered throughout the posterior pole in both eyes [Figure 1]a and [Figure 1]b. Optic discs were small in size in both eyes. The left-eye optic disc showed temporal pallor. Optical coherence tomography confirmed the serous nature of pigment epithelial detachment with normal overlying neurosensory retina [Figure 1]c and [Figure 1]d. Fundus fluorescein angiography revealed hyperflourescent areas corresponding to the pooling of the dye under the PED and scattered multiple tiny hyperflourescent window defects in between the PEDs corresponding to granular retinal pigment epithelial (RPE) atrophic changes [Figure 2]a and [Figure 2]b. MRI brain showed microvascular ischemic changes with mild thinning of optic nerve.
Figure 1: Composite picture of the right (a) and left eye fundus (b) showing multiple serous PED through the posterior pole. The left disc shows temporal pallor. (c and d) OCT through macula confirms serous nature of PED and normal retinal layers over it

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Figure 2: Fundus fluorescein angiography of the right (a) and left eye (b) shows pooling of dye under the PEDs. Blocked fluorescein over PEDs corresponds to pigmentary clumps. No disc leak noted in either eye

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  Discussion Top

Isolated multiple PEDs is a rare presentation of unknown etiology. Widespread primary defect in adhesion between RPE and Bruch's membrane was assumed to be the cause for multiple PEDs.[1] The vision in isolated PED eyes is normal unless complicated by coexisting pathologies such as pachychoroid CSR,[2] hemorrhagic PED,[3] and CNVM[1]. In the present case, the left eye had poor vision secondary to non-arteritic ischemic optic neuropathy. It was a coincidental finding which might be secondary to small disc and underlying systemic risk factors.[4]

The present condition should be differentiated from more common ARMD-associated drusenoid PED. which shows homogenous internal reflectivity on OCT. Other rare entities to be excluded are non-best multifocal vitelliform maculopathy, which shows deposits in the subretinal space on OCT and photoreceptor-RPE diastasis, which presents with serous retinal detachment.[2] Although the macular picture in this case looks dramatic, ophthalmologists should remember that multiple serous PEDs alone cannot cause visual loss. Thus, a thorough search for alternate causes for visual loss should be done.

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There are no conflicts of interest.

  References Top

Gass JD, Bressler SB, Akduman L, Olk J, Caskey PJ, Zimmerman LE. Bilateral idiopathic multifocal retinal pigment epithelium detachments in otherwise healthy middle-aged adults: A clinicopathologic study. Retina 2005;25:304-10.  Back to cited text no. 1
Nagesha CK, Megbelayin EO. Bilateral multifocal retinal pigment epithelium detachment and pachychoroidopathy. Indian J Ophthalmol 2018;66:570-1.  Back to cited text no. 2
[PUBMED]  [Full text]  
Klein ML, Obertynski H, Patz A, Fine SL, Kini M. Follow-up study of detachment of the retinal pigment epithelium. Br J Ophthalmol 1980;64:412-6.  Back to cited text no. 3
Hayreh SS. Management of ischemic optic neuropathies. Indian J Ophthalmol 2011;59:123-36.  Back to cited text no. 4
[PUBMED]  [Full text]  


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