however , other causes have been reported , including central serous chorioretinopathy and post trauma [ 2 , 3 , 4 , 5 ] . up until now , the natural course , predictive factors , and visual outcome of such cases have not been well characterized . by using fundus imaging , optical coherence tomography ( oct ) , and fundus autofluorescence ( faf ) imaging , this study reports 3 patients who developed serous pigment epithelial detachment ( ped ) , which was complicated by giant rpe tear . of the 3 patients , 2 ( 3 eyes ) had a history of systemic corticosteroid use . a 42-year - old man presented a left eye with decreased vision , which he had had for 2 months . he had been treated for bell 's palsy with oral corticosteroid for 3 months prior to presenting his visual symptom . his best - corrected visual acuity ( bcva ) was 6/6 and 6/60 in his right and left eye , respectively . fundus biomicroscopy of the left eye revealed bullous rpe detachment accompanied by a large rpe tear , which had a massive subretinal fibrin along the temporal margin in the posterior pole ( fig . fluorescein angiography ( fa ) of the left eye showed early hyperfluorescence of the bared rpe area , multiple hyperfluorescent leakage dots at the margin of the rpe tear , dye pooling into the rpe detachment and inferior serous retinal detachment in the late phase ( fig . oct of the left eye clearly demonstrated the presence of an rpe tear ( fig . despite ceasing corticosteroid use , the serous detachment continued to progress during the first 3 weeks . one month later , subretinal fluid gradually decreased and completely resolved 3 months after the first visit ( fig . visual acuity improved to 6/9 in the left eye and remained stable over the 6-month follow - up period , with no recurrence of ped . a 47-year - old woman presented with a 2-week history of visual disturbances in her left eye . she had been treated for lupus nephritis with oral prednisolone for 2 months prior to presentation . biomicroscopic examination in the right and left eye revealed a large serous rpe detachment with a thin crescent - shaped rpe tear along the inferior border over the posterior pole ( fig . fa revealed that both eyes had early demarcated hyperfluorescence corresponding to the rpe tear , hypofluorescence that corresponded to the retracted rpe edge , and gradual pooling into the ped area and subretinal space , with no other leakages observed ( fig . 2c , focal choroidal hyperpermeability was evidenced by indocyanine green angiography , superotemporal to the maculae ; and presence of serous rpe detachment and tear was confirmed by oct ( fig . , corticosteroid use was discontinued and the patient switched to other immunosuppressive drugs . during the first 2 weeks , subretinal fluid and rpe tear increased slightly , but gradually resolved and completely resorbed after 2 months ( fig . vision improved to 6/9 in the right eye with foveal sparing , but decreased to counting finger in the left eye with foveal involvement . at 1-year follow - up , oct showed incomplete repopulation of the rpe layer , and faf imaging showed variation in the degree of fluorescence at the margin of the tear , and there was no recurrence of rpe detachment in either eye ( fig . a 56-year - old man with an unremarkable medical history presented with 10 days of metamorphopsia and decreased central vision in his right eye . right fundus examination revealed a 360 rpe tear , with retracted rpe tissue located in the center of the serous detachment ( fig . fa demonstrated hyperfluorescent characteristics of an rpe tear and pooling of subretinal fluid , and the oct disclosed torn retinal pigment epithelium attached to the outer surface of the neurosensory retina ( fig . two weeks later , the patient 's bcva decreased to 6/60 in the right eye , with persistent shallow subretinal fluid and further contraction of rpe tissue ( fig . 2c ) . the fluid resolved slowly but clearly over the next 7 months . at 11-month follow - up , intraretinal exudates and hemorrhage developed ( fig . 3d ) at the centrally retracted rpe area , where fa showed a leakage of dye and oct confirmed the presence of intraretinal fluid ( fig . 3e ) . faf imaging showed granular hyperfluorescence at the margin of the bare retinal pigment epithelium ( fig . a 42-year - old man presented a left eye with decreased vision , which he had had for 2 months . he had been treated for bell 's palsy with oral corticosteroid for 3 months prior to presenting his visual symptom . his best - corrected visual acuity ( bcva ) was 6/6 and 6/60 in his right and left eye , respectively . fundus biomicroscopy of the left eye revealed bullous rpe detachment accompanied by a large rpe tear , which had a massive subretinal fibrin along the temporal margin in the posterior pole ( fig . fluorescein angiography ( fa ) of the left eye showed early hyperfluorescence of the bared rpe area , multiple hyperfluorescent leakage dots at the margin of the rpe tear , dye pooling into the rpe detachment and inferior serous retinal detachment in the late phase ( fig . oct of the left eye clearly demonstrated the presence of an rpe tear ( fig . despite ceasing corticosteroid use , the serous detachment continued to progress during the first 3 weeks . one month later , subretinal fluid gradually decreased and completely resolved 3 months after the first visit ( fig . visual acuity improved to 6/9 in the left eye and remained stable over the 6-month follow - up period , with no recurrence of ped . a 47-year - old woman presented with a 2-week history of visual disturbances in her left eye . she had been treated for lupus nephritis with oral prednisolone for 2 months prior to presentation . biomicroscopic examination in the right and left eye revealed a large serous rpe detachment with a thin crescent - shaped rpe tear along the inferior border over the posterior pole ( fig . fa revealed that both eyes had early demarcated hyperfluorescence corresponding to the rpe tear , hypofluorescence that corresponded to the retracted rpe edge , and gradual pooling into the ped area and subretinal space , with no other leakages observed ( fig . focal choroidal hyperpermeability was evidenced by indocyanine green angiography , superotemporal to the maculae ; and presence of serous rpe detachment and tear was confirmed by oct ( fig . corticosteroid use was discontinued and the patient switched to other immunosuppressive drugs . during the first 2 weeks , subretinal fluid and rpe tear increased slightly , but gradually resolved and completely resorbed after 2 months ( fig . vision improved to 6/9 in the right eye with foveal sparing , but decreased to counting finger in the left eye with foveal involvement . at 1-year follow - up , oct showed incomplete repopulation of the rpe layer , and faf imaging showed variation in the degree of fluorescence at the margin of the tear , and there was no recurrence of rpe detachment in either eye ( fig . a 56-year - old man with an unremarkable medical history presented with 10 days of metamorphopsia and decreased central vision in his right eye . right fundus examination revealed a 360 rpe tear , with retracted rpe tissue located in the center of the serous detachment ( fig . fa demonstrated hyperfluorescent characteristics of an rpe tear and pooling of subretinal fluid , and the oct disclosed torn retinal pigment epithelium attached to the outer surface of the neurosensory retina ( fig . two weeks later , the patient 's bcva decreased to 6/60 in the right eye , with persistent shallow subretinal fluid and further contraction of rpe tissue ( fig . 2c ) . the fluid resolved slowly but clearly over the next 7 months . at 11-month follow - up , intraretinal exudates and hemorrhage developed ( fig . 3d ) at the centrally retracted rpe area , where fa showed a leakage of dye and oct confirmed the presence of intraretinal fluid ( fig . 3e ) . faf imaging showed granular hyperfluorescence at the margin of the bare retinal pigment epithelium ( fig . nevertheless , tractional and shearing forces have been proposed as the underlying pathogenesis in some cases of cnv and trauma , while alteration in the function of the choriocapillaris - bruch 's membrane - rpe complex resulting in accumulation of the sub - rpe fluid had been assumed in the rest . the other one ( case 3 ) had unilateral presentation with none of the risk factors . this implies that corticosteroids may be an accelerating factor rather than a direct cause of rpe tear . after discontinuation of corticosteroid use in case 1 and 2 , serous detachment increased initially within the first 2 weeks , but resolved rapidly in 2 months . on the other hand , resolution of the detachment was observed from the start and eventually resolved after 7 months of follow - up in the patient who did not use corticosteroids . from oct images , no tractional signs of the vitreoretinal interface or any of the intraretinal structures were observed . then , massive hydrostatic pressure beneath the retinal pigment epithelium could lead to large rpe tears in these cases . corticosteroids , either by exogenous administration or endogenous secretion , also have been implicated as a potential risk factor for developing or exacerbating acute rapid exudative macular and chronic bullous exudative retinal detachment [ 7 , 8 ] . .   postulated that different effects of posttranslational corticosteroids in each patient could possibly lead to a varied response of choroidal vascular and rpe modulation , with or without a history of receiving corticosteroids . in the event of rpe tears with foveal sparing , resolution of serous detachment has been reported with favorable visual outcomes [ 4 , 7 , 10 ] . our patients with extrafoveal tears also showed good visual recovery , which is consistent with previous reports . . peiretti et al .   demonstrated the repopulation of torn retinal pigment epithelium , which was documented with oct and faf imaging . in 1 of the cases described here , rpe regeneration was also detected over the tear by color fundus photography , oct , and faf even though the regeneration was not complete at the end of follow - up . faf of this patient revealed irregularity of hyperfluorescence at the margin of tears , which was postulated as decreased rpe cells containing lipofuscin , as well as central hypofluorescence corresponding to the area of absence in rpe cells . cnv was detected 11 months following rpe tear in 1 of our reported cases with no history of corticosteroid use , making it plausible that cnv occurred secondarily and did not contribute to the initial tear . in summary , this report presented unusual cases of spontaneous tear of large serous ped with spontaneous resolution and no evidence of recurrence . advanced technology , including angiography , oct , and faf , is useful in differentiating between diagnoses or confirming the correct diagnosis and following the natural course of diseases . although there is no specific treatment for rpe tear , eyes with this condition should be followed closely , so that proper management can be granted in the event of complications such as cnv .
purposeto report cases of spontaneous retinal pigment epithelial ( rpe ) tear complicating serous pigment epithelial detachment ( ped).methodsthe records of 3 asian patients with spontaneous giant rpe tear were reviewed retrospectively by including clinical presentation , angiography , optical coherence tomography , fundus autofluorescence imaging , and visual outcome.resultsthree patients ( 4 eyes ) were included in this study , with a mean age of 48.3 ( 4256 ) years , and a mean follow - up period of 7.75 ( 418 ) months . 
 fundus examination in all patients showed giant rpe tear associated with bullous ped . 
 two cases had a history of prior corticosteroid use , and 1 had no history of medication use . 
 all 3 patients developed spontaneous resolution of subretinal fluid with no treatment . 
 however , in patients who used corticosteroids , initial progression of the tear and subretinal fluid were observed despite ceasing medication . on subsequent follow - up , 
 an incomplete rpe regeneration was demonstrated by fundus autofluorescence imaging , and choroidal neovascularization developed in 1 patient.conclusionlarge ped with rpe tear is a rare manifestation . 
 when the fovea is spared , visual prognosis is favorable . 
 no specific treatment is required , but careful choroidal neovascularization monitoring should be performed .