RPE Rip Red-free Photograph Image courtesy of

RPE Rip

Red-free Photograph Image courtesy of J Slakter

Red-free Photograph l Red-free photograph: – Shallow subretinal fluid – Drusen l Note the area just temporal to the centre of the macula that appears to be hypopigmented (arrow)

Early-phase Fluorescein Angiogram Image courtesy of J Slakter

Early-phase Fluorescein Angiogram l Early (arterial) phase: – The most important frame l Note the oval area of mild hyperfluorescence occurring when the retinal arteries are just filling l The choroid is also just beginning to fill – Horizontally oriented vessels represent larger choroidal vessels seen through a rip of the RPE

Mid-phase Fluorescein Angiogram Image courtesy of J Slakter

Mid-phase Fluorescein Angiogram l Mid-phase: – Well-circumscribed hyperfluorescent area with curved outer border and almost straight line margin adjacent to an area of relative hypofluorescence – Findings are typical of RPE rips and should act as clues to the diagnosis

Mid-phase Fluorescein Angiogram l By only examining this image and the one that follows, this can be mistaken for classic CNV – The very early image helps to make the correct diagnosis l This can also be misdiagnosed as geographic atrophy, which has: – A border that is geographic not linear – A lesion with no overlying retinal detachment

Late-phase Fluorescein Angiogram Image courtesy of J Slakter

Late-phase Fluorescein Angiogram l Late phase: – Increased hyperfluorescence with mild leakage at margins l Again, this can easily be confused with the pattern seen with classic CNV if the entire study is not examined, including the red-free image