Retinal pigment epithelium apertures as a late complication of longstanding serous pigment epithelium detachments in chronic central serous chorioretinopathy

Background: To report retinal pigment epithelium (RPE) apertures as a possible evolution of serous pigment epithelium detachment (PED) in patients with chronic central serous chorioretinopathy (CSC) and to analyze their progression over time. Design: Retrospective case series. Methods: Fifteen patients (17 eyes) with a diagnosis of avascular PED in chronic CSC were retrospectively evaluated based on multimodal imaging. All patients had documented records of clinical examination, best correct visual acuity (BCVA), fundus autofluorescence (FAF), fluorescein and indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography (OCT-A). Primary outcomes measures were RPE aperture imaging analysis along with their temporal course. Results: All eyes showed the RPE aperture as an interruption of the RPE in correspondence of the PED with neither sign of rippling nor retraction. Mean age was 59.4 ± 8.1 years and mean BCVA was 0.34 ± 0.24 logMAR. In all eyes, FAF displayed a well-circumscribed roundish hypoautofluorescence. Multimodal imaging and OCT-A confirmed the absence of any vascular network beneath the aperture in all study eyes. The mean time of follow-up was 19.3 ± 14.3 months, and RPE discontinuities showed an increase in size over time from 0.81 ± 0.39 mm2 to 0.95 ± 0.45 (P = 0.005). Conclusions: RPE aperture is a new finding in the setting of chronic CSC and it should be distinguished by RPE tears for the different pathogenesis and evolution in time.