Intravitreal Anti-Vascular Endothelial Growth Factor for Retinal Pigment Epithelial Tear in Retinal Angiomatous Proliferation

PURPOSE: To evaluate the treatment outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) therapy for retinal pigment epithelial (RPE) tear in retinal angiomatous proliferation (RAP). METHODS: In the present study we retrospectively analyzed the medical records of 14 patients (14 eyes) diagnosed with RPE tear secondary to RAP treated with intravitreal anti-VEGF. Best-corrected visual acuity (BCVA) when the RPE tear developed was compared with BCVA at 6 months and at the final follow-up. RESULTS: The mean age of the study patients was 75.1 +/- 7.0 years and the mean follow-up period was 23.7 +/- 13.7 months. During the follow-up period, patients were treated with a mean of 2.8 +/- 1.3 intravitreal anti-VEGF injections. The mean logarithm of minimal angle of resolution BCVA when the RPE tear developed, at 6 months and at the final follow-up was 1.25 +/- 0.44, 1.44 +/- 0.56, and 1.65 +/- 0.39, respectively. The BCVA at 6 months was not different from the baseline value (p = 0.258), whereas the BCVA at the final follow-up was significantly worse than the baseline value (p = 0.002). CONCLUSIONS: The prognosis of RPE tear in RAP is poor despite anti-VEGF therapy. This result suggests further investigations regarding the prevention of RPE tear or more effective treatment method for this condition are necessary.

Spectral domain optical coherence tomography features of multiple subfoveal retinal pigment epithelial tears after intravitreal bevacizumab.

Retinal pigment epithelial (RPE) tear has been described to occur spontaneously, after laser photocoagulation and in recent times, after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. In the latter case, the rapid contraction of the choroidal vascular membrane underneath a serous RPE detachment is believed to be the underlying cause. Preservation of good visual acuity after the occurrence of RPE tear with continued use of intravitreal VEGF agents has been reported. In this case report, we describe the occurrence of multiple RPE tears with the use of intravitreal bevacizumab and also correlate the preservation of visual acuity with features seen on spectral domain optical coherence tomography.

Angiographic Findings of Retinal Pigment Epithelial Tear in Age-related Macular Degeneration

The retinal pigment epithelial tear(RPE tear)has been recognized as a complication of the retinal pigment epithelial detachment(PED)in the age-related macular degeneration(AMD)with or without choroidal neovascularization(CNV). CNV was known to play a role in the formation of the RPE tear. However, fluorescein angiographic(FAG) evidence of CNV was hardly observed. A 74-year-old AMD patient with a folded and retracted RPE and associated fibrovascular PED in a subfoveal area was studied with FAG and indocyanine green angiography(ICGA). The area of exposed choroid by the torn RPE showed intense hyperfluorescence on FAG and hypofluores-cence on ICGA. The area of folded and retracted flap of RPE disclosed marked hypofluorescence on FAG and hyperfluorescence on ICGA. ICGA demonstrated the presence of CNV in the RPE tear secondary to AMD.