Bilateral Idiopathic Recrudescent Multifocal Retinal Pigment Epithelial Detachments in a Patient underwent intraocular surgery after Eye Injury: a Case Report

Bilateral Idiopathic Recrudescent Multifocal Retinal Pigment Epithelial Detachments in a Patient underwent intraocular surgery after Eye Injury: a Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Bilateral Idiopathic Recrudescent Multifocal Retinal Pigment Epithelial Detachments in a Patient underwent intraocular surgery after Eye Injury: a Case Report Siyu Wang, Yuedong Hu, Limin Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4420845/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Bilateral multifocal retinal pigment epithelial detachment (RPED) is a rarely observed entity. Such condition is mostly seen in some idiopathic ocular or systemic pathologies. We report a case of bilateral idiopathic recrudescent multifocal retinal pigment epithelial detachment in a patient after eye injury and traumatic cataract surgery. Case presentation The patient is a middle-aged Asian male who developed bilateral multifocal RPED in both eyes following left eye trauma and surgery. The RPED disappeared after conservative treatment but recurred after the implantation of the secondary intraocular lens. There are currently few reports of similar cases involving recurrent bilateral multifocal RPED. Conclusions Comprehensive ophthalmological examinations and thorough systemic assessments are crucial to rule out underlying conditions. While some reports suggest that treatment may not be necessary, appropriate non-invasive treatment may help accelerate the pace of recovery. Retinal Pigment epithelial detachment bilateral PED eye trauma traumatic cataract surgery Figures Figure 1 Figure 2 Background Retinal Pigment epithelial detachment (RPED) is an ocular finding that the basal layer of the retinal pigment epithelium (RPE) is separated from the innermost layer of Bruch’s membrane ( 1 ). RPED is mostly seen in eye diseases such as central serous chorioretinopathy (CSC), age-related macular degeneration (AMD), Vogt–Koyanagi–Harada disease (VKH), polypoidal choroidal vasculopathy (PCV), hypertensive choroidopathy, acute retinal pigment epitheliitis (Kyrill disease), choroidal tumors, and other systemic associations include systemic hypercortisolism, renal disorders, leukemia, ankylosing spondylitis (AS), and in malignant hypertension ( 2 – 7 ). In this paper, we presented a case of bilateral idiopathic recrudescent multifocal RPED in a patient after eye Injury and traumatic cataract surgery. Case presentation A 49-year-old Asian male presented to our clinic with the complaint of left eye injury for 19 days. His left eye was hurt by metal 19 days ago and presented to the local emergency department for corneal suturing. He had not presented with diabetes, hypertension, or any other systemic disorder. The best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.01 in the left eye. Orbits, eyelids, conjunctivae, and sclera were normal in both eyes (BE). The corneal scar and suture could be seen across the pupil area, keratic precipitate (KP) was presented, the iris was mildly synechiae, which can be dilated to 4.5mm and the lens was opacification in the left eye (LE). The other anterior segment was normal in BE. The posterior segment was normal in the right eye (RE) and couldn’t see clearly in LE. The intraocular pressure was 15 mmHg in RE and 10 mmHg in LE. The patient had applied a subconjunctival injection with a mydriatic mixture (epinephrine 0.3ml; atropine 0.3ml and lidocaine 0.2ml) and underwent traumatic cataract surgery without intraocular lens (IOL) planted of LE 8 days later. The patient was presented to our clinic for postoperative re-examination 20 days later. BCVA is 0.8 in RE and 0.12 in LE (corrected by + 10.0D lens). The anterior segment was normal in BE besides the corneal scar and absence of the lens in LE. However, two orangish well-circumscribed elevations in RE and one in LE were revealed during the fundus examination, consistent with RPEDs. (Fig. 1 .a) Optical coherence tomography (OCT) was then performed and showed the presence of one well-demarcated, abrupt elevation of the RPE with a homogenously hypo-reflective sub-RPE space in the LE and two small well-demarcated elevations of the RPE in RE, which were considered to be RPEDs. (Fig. 1 .b) The foveal area was normal in RE but thickened in LE with a low reflection signal between RPE layers. Ocular ultrasonography and systemic examinations like the T-spots test were applied to identify any related eye primary disease or systemic disorder. Given the negative results of all examinations, the patient was diagnosed as Idiopathic RPED of unknown etiology and was treated with JOLETHIN (1.5mg, three times a day), Calcium Dobesilate (0.5g, three times a day), Mecobalamin (0.5mg, three times a day) per os and BRONUCK ophthalmic solution (one drop, two times a day) for BE. The patient underwent OCT again 3 months later, which showed the RPEDs in RE were enlarged and no obvious change in LE. (Fig. 1 .c) The treatments were changed to Mecobalamin (0.5mg, three times a day) and Ginaton (40mg, three times a day) per os. However 2 months later, both fundus exam and scanning laser ophthalmoscope (SLO) showed that the RPEDs in both eyes unexpectedly disappeared. (Fig. 2 .a) The OCT also confirmed this change. (Fig. 2 .b) The BCVA changed to 0.6 in RE and remained 0.12 (corrected by + 10.0D lens) in LE. The patient then underwent secondary intraocular lens implantation 5 days later and the BCVA was improved up to 0.25 in LE and remained at 0.6 in RE. However 7 days later, the RPEDs reappeared in the same position in both eyes when the patient came for the postoperative check. (Fig. 2 .c) However, the patient didn’t feel any loss of vision and the BCVA remained 0.6 in RE and 0.25 in LE. Augentropfen Stulln Mono (one drop, three times a day) and Bronuck Ophthalmic Solution (one drop, two times a day) were applied for BE along with mecobalamine (0.5mg, three times a day), JOLETHIN (1.5mg, three times a day), pancreatic kininogenase enteric-coated tablets (120U, three times a day) per os. 2 weeks later, the follow-up OCT showed that RPEDs in the RE became flattened and remained unchanged in LE. (Fig. 2 .d) The follow-up OCT 1 month later, reveals a tendency of RPEDs to flatten in both eyes. (Fig. 2 .e) During this month, there was no change in the patient’s eye drops or oral medicine. The patient was asked to follow up with any changes in his condition. Discussion Regarding RPED is a non-specific alteration related to many diseases, finding out the etiology is important for the evolution of the process and the proper treatment. if the condition permits, a complete ophthalmologic examination is recommended. A detailed medical history, OCT, fluorescence fundus angiography (FFA), indocyanine green angiography (ICGA), and A/B type ultrasonography do help in differentiating from diseases like AMD, CSC, VKH, PCV, sympathetic ophthalmia, angioid streaks, and lymphoma ( 2 – 7 ). If ophthalmologic examinations can't find a cause, a systemic exam should be carried out including cortisol, leukocytes, erythrocyte sedimentation rate (ESR), C-reactive protein tests, autoimmune markers, and infection serologies tests like CMV, syphilis, herpes simplex, HIV, and tuberculosis ( 8 ). In this case, due to the patient's history of eye trauma, we initially considered it sympathetic ophthalmia. But out of the lack of other typical manifestations and what's more, the RPEDs completely disappear in a short period without the treatment of glucocorticoid, we ruled out this diagnosis and considered it to be an idiopathic multiple RPEDs. In some reports, just like our patient, this kind of idiopathic RPED is considered to be a variant of type CSC which is characterized by attacking males in their middle age under a significant level of stress or emotional disorder ( 8 , 9 ). Regular follow-up and non-invasive therapy are recommended for asymptomatic RPED patients to early detect disease development and timely treatment ( 10 ). A seven-year follow-up case reported that the RPEDs completely disappeared without any treatment in about 7 years. Out case accelerates this tendency, and may demonstrate that appropriate non-invasive treatment can help in recovery. When there is a visual loss, either photodynamic therapy or focal laser photocoagulation has been proven to be useful ( 8 ). When subretinal fluid or choroidal neovascularization is found, anti-vascular endothelial growth factor (anti-VEGF) injection was proved to be a considered treatment option ( 11 ). Conclusion Our case firstly reports a recrudescent multifocal RPED in a relatively short period and demonstrates that appropriate non-invasive treatment does help in recovery. Complete ophthalmologic examination and detailed systemic checkup are essential to exclude any underlying disease. Many reports have proved that they do not require any treatment. However, they should be monitored due to the potential risk of visual loss and choroidal neovascularization. Abbreviations RPED: retinal pigment epithelial detachment RPE: retinal pigment epithelium CSC: central serous chorioretinopathy AMD: age-related macular degeneration VKH: Vogt–Koyanagi–Harada disease PCV: polypoidal choroidal vasculopathy AS: ankylosing spondylitis BCVA: best corrected visual acuity BE: both eyes KP: keratic precipitate LE: left eye RE: right eye IOL: intraocular lens OCT: optical coherence tomography FFA: fluorescence fundus angiography ICGA: indocyanine green angiography ESR: erythrocyte sedimentation rate anti-VEGF: anti-vascular endothelial growth factor Declarations Ethics approval and consent to participate Not applicable. Consent to Publish declaration Written informed consent was obtained from the participant for publication of identifying information/images in an online open-access publication. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions YH and LL provided this case’s medical records. YH provided surgical treatment and LL provided medical treatment. SW was the main drafters of the manuscript. All authors participated in the discussion of the case, under the leadership and instruction of YH. All authors read and approved the final manuscript. Acknowledgements Not applicable References Dave VP, Pappuru RR. Idiopathic multiple retinal pigment epithelial detachments – A case report. Saudi J Ophthalmol. 2015 Oct 1;29(4):295–7. Karatepe Hashas AS, Göktas A, Atas M. Isolated Multiple Pigment Epithelial Detachments with Unknown Cause. Case Rep Ophthalmol Med. 2014 Feb 4;2014:e289107. Jdm G. Pathogenesis of disciform detachment of the neuroepithelium. (II) Idiopathic central serous chorioretinopathy. Am J Ophthalmol. 1967;63:587–615. Yannuzzi LA, Freund KB, Goldbaum M, Scassellati-Sforzolini B, Guyer DR, Spaide RF, et al. Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy. Ophthalmology. 2000 Apr 1;107(4):767–77. Wolfensberger TJ, Tufail A. Systemic disorders associated with detachment of the neurosensory retina and retinal pigment epithelium. Curr Opin Ophthalmol. 2000 Dec;11(6):455. Tang RA, Vila-Coro AA, Wall S, Frankel LS. Acute Leukemia Presenting as a Retinal Pigment Epithelium Detachment. Arch Ophthalmol. 1988 Jan 1;106(1):21–2. Gedar Totuk OM, Toygar O, Cosan F, Yabas Kiziloglu O, Toygar B. Coexistence of bilateral multifocal retinal pigment epithelial detachment and ankylosing spondylitis. Mod Rheumatol Case Rep. 2017 Jul 3;1(2):64–7. Blanco-Domínguez I, Fernández PV, Alvarez AVO, González LMM. Multiple retinal pigment epithelial detachments: what should we do? A propos of an idiopathic case. Rev Bras Oftalmol. 2020 Jun 3;79:138–40. González-Escobar AB, González de Gor-Crooke JL, López-Egea-Bueno MA, García-Campos JM. Multiple retinal pigment epithelial detachments: A case report. Arch Soc Esp Oftalmol Engl Ed. 2014 May 1;89(5):194–8. Rauchegger T, Osl A, Teuchner B, Haas G. Symptomatic idiopathic bilateral multifocal retinal pigment epithelial detachments. Am J Ophthalmol Case Rep. 2022 Mar 1;25:101336. An Incidental Case of Bilateral Multifocal Retinal Pigment Epithelial Detachments in a Patient with Post-Traumatic Stress Disorder: a Teaching Case Report | The Journal of Optometric Education [Internet]. [cited 2023 Feb 4]. Available from: https://journal.opted.org/article/an-incidental-case-of-bilateral-multifocal-retinal-pigment-epithelial-detachments-in-a-patient-with-post-traumatic-stress-disorder-a-teaching-case-report/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4420845","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":304866850,"identity":"e5c6e64e-6f5b-4360-9f8d-2855172c9708","order_by":0,"name":"Siyu Wang","email":"","orcid":"","institution":"the First Affiliated Hospital of China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Siyu","middleName":"","lastName":"Wang","suffix":""},{"id":304866853,"identity":"394a65b6-eb64-488e-a2d8-838e7627b0e6","order_by":1,"name":"Yuedong Hu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBACPjBZIcFj38DA+CChwoawFjYwecZGzoCBgdngwZk0IrUwtqUZA7WwST5sO0SEFvbjDx9XsB1O3M5/xqwige0AA397dwJ+LTw5xoZneA4n7pyRY3YjgecOg8SZsxsIOCyHTbJB4nBiww0eoBaJZwwGErkEtPA/f/6zwQCo5fwZs4IEg8NEaJFIMGNsSAB6/0COGUNCAlFa3hhLNhywkZOckVYskXAgjYegX/j50x9+bPwnwcPPf3jjx5//bOT423vxa0ECHAYgkodY5SDA/oAU1aNgFIyCUTCCAACGEUm1ked7TgAAAABJRU5ErkJggg==","orcid":"","institution":"the First Affiliated Hospital of China Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yuedong","middleName":"","lastName":"Hu","suffix":""},{"id":304866854,"identity":"735cdd96-0594-4a96-bea6-fdc2cc89c477","order_by":2,"name":"Limin Liu","email":"","orcid":"","institution":"the First Affiliated Hospital of China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Limin","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-05-14 17:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4420845/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4420845/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57443814,"identity":"3fb5c66f-91c1-498a-86f3-73b90e10a0dd","added_by":"auto","created_at":"2024-05-30 18:52:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11410695,"visible":true,"origin":"","legend":"\u003cp\u003eCase’s auxiliary examination during the first therapeutic process\u003c/p\u003e\n\u003cp\u003e(a) scanning laser ophthalmoscope of the right eye 20 days later after traumatic cataract surgery (lesion enlargement); (b) OCT of both eyes 20 days later after traumatic cataract surgery; (c) OCT of both eyes 3 months later after traumatic cataract surgery\u003c/p\u003e","description":"","filename":"FIGURE1abc.png","url":"https://assets-eu.researchsquare.com/files/rs-4420845/v1/f52c2887a50aca49a2e86326.png"},{"id":57443816,"identity":"e3b5d16f-8cf1-4760-9392-d58b78cc2389","added_by":"auto","created_at":"2024-05-30 18:52:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15094609,"visible":true,"origin":"","legend":"\u003cp\u003eCase’s auxiliary examination during the recurrence\u003c/p\u003e\n\u003cp\u003e(a) scanning laser ophthalmoscope of the right eye 5 months later after traumatic cataract surgery (lesion enlargement); (b) OCT of the left eyes 5 months later after traumatic cataract surgery; (c) OCT of both eyes 1 week later after secondary intraocular lens implantation; (d) OCT of both eyes 3 weeks later after secondary intraocular lens implantation; (e) OCT of both eyes 2 months later after secondary intraocular lens implantation\u003c/p\u003e","description":"","filename":"FIGURE2abcde.png","url":"https://assets-eu.researchsquare.com/files/rs-4420845/v1/39bc739e8edaf4fc84d6fdb2.png"},{"id":58432376,"identity":"4940e822-1e02-4f0a-b3a3-9b7686ef53f3","added_by":"auto","created_at":"2024-06-16 04:31:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":39001283,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4420845/v1/953d3659-82b0-4e7c-8d70-6fd81c4445c1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bilateral Idiopathic Recrudescent Multifocal Retinal Pigment Epithelial Detachments in a Patient underwent intraocular surgery after Eye Injury: a Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eRetinal Pigment epithelial detachment (RPED) is an ocular finding that the basal layer of the retinal pigment epithelium (RPE) is separated from the innermost layer of Bruch\u0026rsquo;s membrane (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRPED is mostly seen in eye diseases such as central serous chorioretinopathy (CSC), age-related macular degeneration (AMD), Vogt\u0026ndash;Koyanagi\u0026ndash;Harada disease (VKH), polypoidal choroidal vasculopathy (PCV), hypertensive choroidopathy, acute retinal pigment epitheliitis (Kyrill disease), choroidal tumors, and other systemic associations include systemic hypercortisolism, renal disorders, leukemia, ankylosing spondylitis (AS), and in malignant hypertension (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this paper, we presented a case of bilateral idiopathic recrudescent multifocal RPED in a patient after eye Injury and traumatic cataract surgery.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 49-year-old Asian male presented to our clinic with the complaint of left eye injury for 19 days. His left eye was hurt by metal 19 days ago and presented to the local emergency department for corneal suturing. He had not presented with diabetes, hypertension, or any other systemic disorder.\u003c/p\u003e \u003cp\u003eThe best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.01 in the left eye. Orbits, eyelids, conjunctivae, and sclera were normal in both eyes (BE). The corneal scar and suture could be seen across the pupil area, keratic precipitate (KP) was presented, the iris was mildly synechiae, which can be dilated to 4.5mm and the lens was opacification in the left eye (LE). The other anterior segment was normal in BE. The posterior segment was normal in the right eye (RE) and couldn\u0026rsquo;t see clearly in LE. The intraocular pressure was 15 mmHg in RE and 10 mmHg in LE. The patient had applied a subconjunctival injection with a mydriatic mixture (epinephrine 0.3ml; atropine 0.3ml and lidocaine 0.2ml) and underwent traumatic cataract surgery without intraocular lens (IOL) planted of LE 8 days later.\u003c/p\u003e \u003cp\u003eThe patient was presented to our clinic for postoperative re-examination 20 days later. BCVA is 0.8 in RE and 0.12 in LE (corrected by +\u0026thinsp;10.0D lens). The anterior segment was normal in BE besides the corneal scar and absence of the lens in LE. However, two orangish well-circumscribed elevations in RE and one in LE were revealed during the fundus examination, consistent with RPEDs. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.a) Optical coherence tomography (OCT) was then performed and showed the presence of one well-demarcated, abrupt elevation of the RPE with a homogenously hypo-reflective sub-RPE space in the LE and two small well-demarcated elevations of the RPE in RE, which were considered to be RPEDs. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.b) The foveal area was normal in RE but thickened in LE with a low reflection signal between RPE layers.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOcular ultrasonography and systemic examinations like the T-spots test were applied to identify any related eye primary disease or systemic disorder. Given the negative results of all examinations, the patient was diagnosed as Idiopathic RPED of unknown etiology and was treated with JOLETHIN (1.5mg, three times a day), Calcium Dobesilate (0.5g, three times a day), Mecobalamin (0.5mg, three times a day) per os and BRONUCK ophthalmic solution (one drop, two times a day) for BE.\u003c/p\u003e \u003cp\u003eThe patient underwent OCT again 3 months later, which showed the RPEDs in RE were enlarged and no obvious change in LE. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.c) The treatments were changed to Mecobalamin (0.5mg, three times a day) and Ginaton (40mg, three times a day) per os. However 2 months later, both fundus exam and scanning laser ophthalmoscope (SLO) showed that the RPEDs in both eyes unexpectedly disappeared. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.a) The OCT also confirmed this change. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.b) The BCVA changed to 0.6 in RE and remained 0.12 (corrected by +\u0026thinsp;10.0D lens) in LE.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient then underwent secondary intraocular lens implantation 5 days later and the BCVA was improved up to 0.25 in LE and remained at 0.6 in RE. However 7 days later, the RPEDs reappeared in the same position in both eyes when the patient came for the postoperative check. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.c) However, the patient didn\u0026rsquo;t feel any loss of vision and the BCVA remained 0.6 in RE and 0.25 in LE. Augentropfen Stulln Mono (one drop, three times a day) and Bronuck Ophthalmic Solution (one drop, two times a day) were applied for BE along with mecobalamine (0.5mg, three times a day), JOLETHIN (1.5mg, three times a day), pancreatic kininogenase enteric-coated tablets (120U, three times a day) per os.\u003c/p\u003e \u003cp\u003e2 weeks later, the follow-up OCT showed that RPEDs in the RE became flattened and remained unchanged in LE. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.d) The follow-up OCT 1 month later, reveals a tendency of RPEDs to flatten in both eyes. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.e) During this month, there was no change in the patient\u0026rsquo;s eye drops or oral medicine. The patient was asked to follow up with any changes in his condition.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRegarding RPED is a non-specific alteration related to many diseases, finding out the etiology is important for the evolution of the process and the proper treatment. if the condition permits, a complete ophthalmologic examination is recommended. A detailed medical history, OCT, fluorescence fundus angiography (FFA), indocyanine green angiography (ICGA), and A/B type ultrasonography do help in differentiating from diseases like AMD, CSC, VKH, PCV, sympathetic ophthalmia, angioid streaks, and lymphoma (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIf ophthalmologic examinations can't find a cause, a systemic exam should be carried out including cortisol, leukocytes, erythrocyte sedimentation rate (ESR), C-reactive protein tests, autoimmune markers, and infection serologies tests like CMV, syphilis, herpes simplex, HIV, and tuberculosis (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this case, due to the patient's history of eye trauma, we initially considered it sympathetic ophthalmia. But out of the lack of other typical manifestations and what's more, the RPEDs completely disappear in a short period without the treatment of glucocorticoid, we ruled out this diagnosis and considered it to be an idiopathic multiple RPEDs.\u003c/p\u003e \u003cp\u003eIn some reports, just like our patient, this kind of idiopathic RPED is considered to be a variant of type CSC which is characterized by attacking males in their middle age under a significant level of stress or emotional disorder (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Regular follow-up and non-invasive therapy are recommended for asymptomatic RPED patients to early detect disease development and timely treatment (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). A seven-year follow-up case reported that the RPEDs completely disappeared without any treatment in about 7 years. Out case accelerates this tendency, and may demonstrate that appropriate non-invasive treatment can help in recovery. When there is a visual loss, either photodynamic therapy or focal laser photocoagulation has been proven to be useful (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). When subretinal fluid or choroidal neovascularization is found, anti-vascular endothelial growth factor (anti-VEGF) injection was proved to be a considered treatment option (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur case firstly reports a recrudescent multifocal RPED in a relatively short period and demonstrates that appropriate non-invasive treatment does help in recovery. Complete ophthalmologic examination and detailed systemic checkup are essential to exclude any underlying disease. Many reports have proved that they do not require any treatment. However, they should be monitored due to the potential risk of visual loss and choroidal neovascularization.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRPED: retinal pigment epithelial detachment\u003c/p\u003e\n\u003cp\u003eRPE: retinal pigment epithelium\u003c/p\u003e\n\u003cp\u003eCSC: central serous chorioretinopathy\u003c/p\u003e\n\u003cp\u003eAMD: age-related macular degeneration\u003c/p\u003e\n\u003cp\u003eVKH: Vogt\u0026ndash;Koyanagi\u0026ndash;Harada disease\u003c/p\u003e\n\u003cp\u003ePCV: polypoidal choroidal vasculopathy\u003c/p\u003e\n\u003cp\u003eAS: ankylosing spondylitis\u003c/p\u003e\n\u003cp\u003eBCVA: best corrected visual acuity\u003c/p\u003e\n\u003cp\u003eBE: both eyes\u003c/p\u003e\n\u003cp\u003eKP: keratic precipitate\u003c/p\u003e\n\u003cp\u003eLE: left eye\u003c/p\u003e\n\u003cp\u003eRE: right eye\u003c/p\u003e\n\u003cp\u003eIOL: intraocular lens\u003c/p\u003e\n\u003cp\u003eOCT: optical coherence tomography\u003c/p\u003e\n\u003cp\u003eFFA: fluorescence fundus angiography\u003c/p\u003e\n\u003cp\u003eICGA: indocyanine green angiography\u003c/p\u003e\n\u003cp\u003eESR: erythrocyte sedimentation rate\u003c/p\u003e\n\u003cp\u003eanti-VEGF: anti-vascular endothelial growth factor\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eConsent to Publish declaration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the participant for publication of identifying information/images in an online open-access publication.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYH\u0026nbsp;and LL provided this case\u0026rsquo;s medical records. YH provided surgical treatment and LL provided medical treatment. SW was the main drafters of the manuscript. All authors participated in the discussion of the case, under the leadership and instruction of YH. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDave VP, Pappuru RR. Idiopathic multiple retinal pigment epithelial detachments \u0026ndash; A case report. Saudi J Ophthalmol. 2015 Oct 1;29(4):295\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKaratepe Hashas AS, G\u0026ouml;ktas A, Atas M. Isolated Multiple Pigment Epithelial Detachments with Unknown Cause. Case Rep Ophthalmol Med. 2014 Feb 4;2014:e289107. \u003c/li\u003e\n\u003cli\u003eJdm G. Pathogenesis of disciform detachment of the neuroepithelium. (II) Idiopathic central serous chorioretinopathy. Am J Ophthalmol. 1967;63:587\u0026ndash;615. \u003c/li\u003e\n\u003cli\u003eYannuzzi LA, Freund KB, Goldbaum M, Scassellati-Sforzolini B, Guyer DR, Spaide RF, et al. Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy. Ophthalmology. 2000 Apr 1;107(4):767\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eWolfensberger TJ, Tufail A. Systemic disorders associated with detachment of the neurosensory retina and retinal pigment epithelium. Curr Opin Ophthalmol. 2000 Dec;11(6):455. \u003c/li\u003e\n\u003cli\u003eTang RA, Vila-Coro AA, Wall S, Frankel LS. Acute Leukemia Presenting as a Retinal Pigment Epithelium Detachment. Arch Ophthalmol. 1988 Jan 1;106(1):21\u0026ndash;2. \u003c/li\u003e\n\u003cli\u003eGedar Totuk OM, Toygar O, Cosan F, Yabas Kiziloglu O, Toygar B. Coexistence of bilateral multifocal retinal pigment epithelial detachment and ankylosing spondylitis. Mod Rheumatol Case Rep. 2017 Jul 3;1(2):64\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eBlanco-Dom\u0026iacute;nguez I, Fern\u0026aacute;ndez PV, Alvarez AVO, Gonz\u0026aacute;lez LMM. Multiple retinal pigment epithelial detachments: what should we do? A propos of an idiopathic case. Rev Bras Oftalmol. 2020 Jun 3;79:138\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez-Escobar AB, Gonz\u0026aacute;lez de Gor-Crooke JL, L\u0026oacute;pez-Egea-Bueno MA, Garc\u0026iacute;a-Campos JM. Multiple retinal pigment epithelial detachments: A case report. Arch Soc Esp Oftalmol Engl Ed. 2014 May 1;89(5):194\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRauchegger T, Osl A, Teuchner B, Haas G. Symptomatic idiopathic bilateral multifocal retinal pigment epithelial detachments. Am J Ophthalmol Case Rep. 2022 Mar 1;25:101336. \u003c/li\u003e\n\u003cli\u003eAn Incidental Case of Bilateral Multifocal Retinal Pigment Epithelial Detachments in a Patient with Post-Traumatic Stress Disorder: a Teaching Case Report | The Journal of Optometric Education [Internet]. [cited 2023 Feb 4]. Available from: https://journal.opted.org/article/an-incidental-case-of-bilateral-multifocal-retinal-pigment-epithelial-detachments-in-a-patient-with-post-traumatic-stress-disorder-a-teaching-case-report/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Retinal Pigment epithelial detachment, bilateral PED, eye trauma, traumatic cataract surgery","lastPublishedDoi":"10.21203/rs.3.rs-4420845/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4420845/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBilateral multifocal retinal pigment epithelial detachment (RPED) is a rarely observed entity. Such condition is mostly seen in some idiopathic ocular or systemic pathologies. We report a case of bilateral idiopathic recrudescent multifocal retinal pigment epithelial detachment in a patient after eye injury and traumatic cataract surgery.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eThe patient is a middle-aged Asian male who developed bilateral multifocal RPED in both eyes following left eye trauma and surgery. The RPED disappeared after conservative treatment but recurred after the implantation of the secondary intraocular lens. There are currently few reports of similar cases involving recurrent bilateral multifocal RPED.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eComprehensive ophthalmological examinations and thorough systemic assessments are crucial to rule out underlying conditions. While some reports suggest that treatment may not be necessary, appropriate non-invasive treatment may help accelerate the pace of recovery.\u003c/p\u003e","manuscriptTitle":"Bilateral Idiopathic Recrudescent Multifocal Retinal Pigment Epithelial Detachments in a Patient underwent intraocular surgery after Eye Injury: a Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-30 18:52:32","doi":"10.21203/rs.3.rs-4420845/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"42c4afd4-223c-40d0-988f-897e9c58f106","owner":[],"postedDate":"May 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-16T04:23:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-30 18:52:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4420845","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4420845","identity":"rs-4420845","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}