A 46-year-old man, who had had idiopathic multiple serous retinal pigment epithelial detachments (PEDs)1 bilaterally for more than 7 years (Figure 1), also had a bullous retinal detachment2,3 accompanied by fibrinous exudates in the left eye (Figure 2A). We detected the leakage point at the edge of the largest PED in the macular area (Figure 3A). Extensive leakage in the middle phase of fluorescein angiography (Figure 3B) represented the clear space surrounded by fibrinous exudates (Figure 2A). We applied laser photocoagulation to the leakage point. Two weeks later, the fibrinous exudates decreased slightly (Figure 4A). Three-dimensional optical coherence tomography (OCT) (OCT-Ophthalmoscope; Ophthalmic Technologies, Inc, Toronto, Ontario), which can provide transverse en face retinal images at different depths,4,5 showed isolated clear spaces surrounded by high intensity corresponding to multiple PEDs in the superficial layers of the subretinal space (Figure 4C). Posterior consecutive transverse images detected multiple contiguous PEDs in the deeper levels (Figure 4 C-F). Fibrinous exudates and serous fluid adjacent to the edge of the largest PED, which had joined with other PEDs, were seen as areas of moderate and dark intensity in the macular area (Figure 4E). The fibrinous exudates completely disappeared 5 months later. The largest PED in the macular area disappeared, and small PEDs at the temporal macular area became indistinct (Figure 2B).
Fundus photographs of the right (A) and left (B) eyes in 2001. Numerous pigment epithelial detachments (PEDs) are seen bilaterally, especially in the macular area of the left eye. The largest PED is seen in the macular area of the left eye. The patient’s visual acuity was 20/15 OD and 20/20 OS.
Color fundus photographs of the left eye when the patient was examined in 2003 (A) and 5 months later (B). A, Submacular fibrinous exudates due to a bullous retinal detachment are evident. The visual acuity (VA) in the left eye decreased to 20/300 in 2003. B, Five months later, fibrinous exudates completely disappeared and the VA improved to 20/20. The large subfoveal pigment epithelial detachments (PEDs) collapsed and small PEDs in the temporal area flattened.
Early-phase (A) and middle-phase (B) fluorescein angiography of the left eye. A, Hyperfluorescence of multiple pigment epithelial detachments (PEDs) in the temporal area and a leakage point at the edge of the largest PED in the macular area are visible in the early phase. B, Heavy leakage is seen in the middle phase. Extensive leakage represents the clear space surrounded by fibrinous exudates in Figure 2A.
Fundus photographic (A), scanning laser ophthalmoscopic (SLO) (B), and consecutive transverse optical coherence tomographic (OCT) (C-F) images of the left eye 2 weeks after laser treatment. A, Fundus photograph 2 weeks after laser treatment shows decreased fibrinous exudates. B, An SLO image of the area where transverse en-face images were scanned. C through F, Consecutive transverse OCT images correspond to the SLO image (B) at different depths. A round, highly reflective, broad band (large arrowhead) indicates the retinal pigment epithelium and Bruch membrane layer. This highly reflective band became smaller with depth, as seen in the later frames in the posterior. Retinal vessels are indicated by the dark intensity in each OCT image. Multiple, round clear spaces surrounded by an area of high intensity (small arrows) corresponding to pigment epithelial detachments (PEDs) at a superficial level (C) are connected in the deeper layers (D-F). Moderate reflection with partial dark intensity (small arrowheads) in the macular area represents the fibrinous exudates with serous fluid corresponding to that seen in panel A. D, An isolated PED (large arrow) is detected near the optic nerve head.
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