J Korean Ophthalmol Soc.  2014 Sep;55(9):1340-1346. 10.3341/jkos.2014.55.9.1340.

Long-Term Observation of Retinal Pigment Epithelial Tear after Anti-VEGF Treatment for Age-Related Macular Degeneration

• Park JH
• Choae WS
• Yoon HS

• KMID: 2217118
• DOI: http://doi.org/10.3341/jkos.2014.55.9.1340

Abstract

PURPOSE
To evaluate the long-term clinical outcomes of retinal pigment epithelium (RPE) tears after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (AMD).
METHODS
The authors performed a retrospective chart review of 13 eyes of 13 patients who developed RPE tears after intravitreal anti-VEGF injection between February 2009 and June 2013. We investigated continuation of the treatment after tear, visual acuity, presence of cystoid macular edema, and central macular thickness (CMT) using optical coherence tomography (OCT) before and after treatment and visual outcomes depending on foveal sparing.
RESULTS
After RPE tear, 12 of 13 patients continued injection of an anti-VEGF agent. The average number of injections was 6.08 +/- 5.18. Mean visual acuity immediately after tear was 1.65 +/- 0.8 log MAR, and that at the last visit was 1.82 +/- 0.88 log MAR. Nine eyes with macular edema in OCT continued receiving injection, and improvement of macular edema was observed in four eyes at the final visit. The final visual acuity of patients with foveal involvement was 2.17 +/- 0.49 log MAR, which was worse than the 1.51 +/- 1.06 log MAR in patients without foveal involvement, although the difference was not significant (p = 0.295).
CONCLUSIONS
When anti-VEGF injections were continued after RPE tear, no improvement in visual acuity was observed, although better anatomical outcomes did result. Patients with foveal involvement had worse visual acuity than patients without foveal involvement, but the difference was not significant.

Keyword

Anti-VEGF treatment; Intravitreal injection; Pigment epithelial detachment (PED); RPE tear; Wet AMD

MeSH Terms

Endothelial Growth Factors
Humans
Intravitreal Injections
Macular Degeneration*
Macular Edema
Retinal Pigment Epithelium
Retinaldehyde*
Retrospective Studies
Tomography, Optical Coherence
Visual Acuity
Endothelial Growth Factors
Retinaldehyde

Figure

• 

  Figure 1. The optical coherence tomography (OCT) images of 78-year-old male with retinal pigment epithelium (RPE) tear in wet age-related macular degeneration (AMD). The patients had discontinued the anti-VEGF injection after RPE tear. (A) There is no macular edema at the day of RPE tear. (B) Cystoid macular edema was detected on OCT image of the final follow-up day at 16 months after RPE tear. VEGF = vascular endothelial growth factor.

• 

  Figure 2. The optical coherence tomography (OCT) images of 84-year-old male patient with continuing anti-VEGF treatment after retinal pigment epithelium (RPE) tear. The patient had been treated with bevacizumab on five times over period of 6 months. (A) The OCT shows cystic edema and a neurosensory detachment with reflectance that could represent the neovascularization complex. (B) The detachment resolved, and there is no persistent cystic change within the retina. VEGF = vascular endothelial growth factor.

Reference

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