J Korean Ophthalmol Soc.  2013 Oct;54(10):1546-1553.

Risk Factors for Retinal Pigment Epithelium Tears after Anti-VEGF Agent Injection in Age-Related Macular Degeneration

• Choae WS
• Park JH
• Lee WS
• Kim SW
• Yoon HS

Abstract

PURPOSE
Intravitreal anti-vascular endothelial growth factor (VEGF) treatment has become an important part in the treatment of neovascular age-related macular degeneration (AMD). In the present study we describe the clinical feature of retinal pigment epithelium (RPE) tears after intravitreal injection of anti-VEGF agent and compared the tear group to the control group.
METHODS
In this retrospective case series, data of 11 patients with eyes that developed RPE tears after intravitreal anti-VEGF injection (8 ranibizumab and 3 bevacizumab) were collected and analyzed. The tear group included 11 patients with eyes that developed RPE tears and the control group included 22 patients with no RPE tears after treatment. We investigated age, gender, bilaterality, duration from injection to tear, pigment epithelial detachment (PED) height and diameter, along with central retinal thickness (CMT) using optical coherence tomography (OCT), fluorescein angiography (FAG), and visual acuities before and after treatment.
RESULTS
The mean age of the tear group was 81.36 +/- 5.55 years which was significantly different from the control group's mean age of 74.82 +/- 5.28 years (p = 0.003). OCT findings showed PED greatest linear dimension (GLD) was 2978.45 +/- 947.69 microm in the tear group and 2250.23 +/- 988.49 microm in the control group (p = 0.027). PED height was 507.09 +/- 153.97 microm in the tear group and 353.23 +/- 199.42 microm in the control group (p = 0.010). CMT was 431.64 +/- 200.33 microm in the tear group and 289.95 +/- 61.27 microm in the control group (p = 0.005). There was no significant difference between groups according to gender, bilaterality, visual acuities, and subretinal fluid based on OCT and FAG findings. In the tear group, visual acuities before and after the tear were not significantly different.
CONCLUSIONS
Old age and eyes with high and wide PED appear to be more vulnerable to RPE tear. Further investigation with a larger number of patients is needed to further confirm these results.

Keyword

Bevacizumab; Intravitreal injection; PED; Ranibizumab; RPE tear

MeSH Terms

Antibodies, Monoclonal, Humanized
Endothelial Growth Factors
Eye
Fluorescein Angiography
Humans
Intravitreal Injections
Macular Degeneration*
Retinal Pigment Epithelium*
Retinaldehyde*
Retrospective Studies
Risk Factors*
Subretinal Fluid
Tomography, Optical Coherence
Visual Acuity
Bevacizumab
Ranibizumab
Antibodies, Monoclonal, Humanized
Endothelial Growth Factors
Retinaldehyde

Figure

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  Figure 1. A vision preserved case. The foveal area is saved from the missing RPE bed area after the RPE tear had occurred (right). The contracted sheath of RPE is under the foveal area. Visual acuity is increased.

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  Figure 2. A vision deprived case. Fundus photo and OCT demonstrates a large PED before treatment (left) and RPE tear after treatment (right). In the right image, the fovea is on the RPE missing area and has cysts on OCT image. Visual acuity is seriously decreased.

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  Figure 3. OCT image measuring of PED height and diameter by using of caliper function in SD-OCT (CIRRUS™ HD-OCT 4000, Carl Zeiss Meditec, Dublin, CA, USA).

Reference

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