Maurice F. Rabb » Serous Detachment Of The Pigment Epithelium

A 71 year old healthy white woman presented because of a two-year history of progressive loss of central vision in the right eye, and recent loss of vision in the left eye. Her past medical history was unremarkable. Her mother had senile macular degeneration. Corrected visual acuity was 20/200 (6/60) in each eye. Refraction for distance in the right eye was +3.00 +0.75 x 175, and in the left eye was +4.00. The eye examination, except for the macular region of both eyes, was normal. In the right macula there was a two-disc-diameter-size, elevated, partly organized, gray-white detachment of the pigment epithelium and retina. In the left macula there was a serous detachment of the pigment epithelium and retina. There was one small fleck of subretinal blood superior to the foveola. Surrounding and radiating outward from the edge of the retinal and pigment epithelial detachment, there were multiple chorioretinal folds.

Angiography revealed evidence of approximately 55 of these folds radiating out to, and in some cases, beyond the edge of the macula. The folds were evident as a series of hyperfluorescent rays, most of which were slightly tapered at either end. These rays were apparent in the retinal arterial phase of angiography, and they faded from view in the later stages of angiography. These hyperfluorescent rays corresponded with the elevated ridges of infolded pigment epithelium. The hypofluorescent zones on either side corresponded with the valleys between the folds. There was angiographic evidence of a chorioretinal folds surrounding the fibrovascular subretinal mass. The folds in this eye were difficult to visualize biomicroscopically.

Comment.-- This patient was referred here for laser treatment of a serous detachment of the pigment epithelium in the left eye. Except for the solitary fleck of subretinal blood and the radial chorioretinal folds, there was no biomicroscopic clue to the presence of choroidal neovascularization.