Clinical science Figure 3 A retinal pigment epithelium (RPE) tear 3 years after the acute event. Colour fundus photography (A) of RPE tear. The white star indicated the presence of intraretinal hard exudates, which appeared hypoﬂuorescent in the corresponding fundus autoﬂuorescence (B) image. The area between the two arrowheads (C) showed the enhanced choroidal hyper-reﬂectivity. A homogenous subretinal mass can also be seen. (D) The intraretinal hard exudates (star in A and B) are presented as a large hyper-reﬂective lesion with shadowing effect (white arrow). This ﬁgure is produced in colour in the online journaldplease visit the website to view the colour ﬁgure. melanin to absorb light in the SD-OCT. The corresponding FAF images showed hypoﬂuorescent area, indicating a lack of lipo- fuscin. These materials were in SD-OCT mostly homogenous and did not form a single layer (ﬁgure 3). In 1 of 36 eyes (2.8%), the RPE tear was relatively small (patient 8). In follow-up visits, the defect in the RPE denuded area was covered with a layer of RPE cells. The hyper-reﬂective area indicated that the RPE denuded area constantly dissipated over time in the corresponding near infrared image. In SD-OCT, a new RPE layer was identiﬁed (ﬁgure 4). The corresponding FAF image in this area remained hypoﬂuorescent, possibly indicating that this new RPE layer lacked lipofuscin. DISCUSSION Wound healing and RPE proliferation of RPE tears have been studied by several authors.6 10 In time domain OCT, the reat- tachment of the RPE layer and RPE repopulation have been documented.7 We also found a considerable tissue remodelling over several years using FAF and SD-OCT. We saw RPE repo- pulation in one case, that is, a small RPE tear which is in line with other reports.8 10 These new RPE cells lacked lipofuscin, as shown in hypoﬂuorescent FAF. Histological studies of RPE tears also reported RPE cell migration and proliferation. In a case reported by Green et al, the RPE proliferated to the underside of the ripped basement Figure 4 A case of self-healing retinal pigment epithelium (RPE) tear. The fundus autoﬂuorescence (A) showed a small RPE defect, which corresponds to an area of enhanced choroidal hyper- reﬂectivity (B) (between arrowheads). Two and a half years after the RPE denuded area has been covered by a single RPE layer (C and D). The black star represents a small atrophy, used as an anatomical landmark, ensuring approximately the same level of SD- OCT measurements over time. 1214 Br J Ophthalmol 2012;96:1211–1216. doi:10.1136/bjophthalmol-2012-301750