Journal List > J Korean Ophthalmol Soc > v.57(1) > 1010577

Hwang, Chang, Kim, Lee, Kim, Cho, Lee, Han, and Kim: Intravitreal Anti-Vascular Endothelial Growth Factor for Retinal Pigment Epithelial Tear in Retinal Angiomatous Proliferation

Abstract

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 mini-mal 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.

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Figure 1.
Fundus photography, fluorescein angiography, indicyanine-green angiography, and optical coherence tomography find-ings in a 72-year-old patient with retinal angiomatous proliferation. In this patient, retinal pigment epithelial tear was noted at diag-nosis (A, B, C, D) and the best-corrected visual acuity at diagnosis was 0.1. The patient was treated with 3 intravitreal ranibizumab injections during the 6 months follow-up period. At 6 months (E, F), the best-corrected visual acuity was decreased to 0.05 despite resolution of fluid. Arrow in figure A and E indicates optical coherence tomography line (figure D and figure F, respectively). Arrowheads in figure A indicate the extent of RPE tear. RPE = retinal pigment epithelial.
jkos-57-71f1.tif
Figure 2.
Fundus photography, fluorescein angiography, indicyanine-green angiography, and optical coherence tomography find-ings in a 71-year-old patient with retinal angiomatous proliferation. In this patient, retinal pigment epithelial tear was developed 1 month (A, B, C, D) following 3 monthly ranibizumab injections (E, F, G). The best-corrected visual acuity (BCVA) 1 month before the retinal pigment epithelial tear was 0.1. The BCVA decreased to 0.02 when retinal pigment epithelial tear was developed. The patient was treated with 2 additional intravitreal bevacizumab injections. At 45 months (H, I), the BCVA was measured as counting finger. Arrow in figure F and H indicates optical coherence tomography line (figure G and I, respectively). Arrowheads in figure E indicate the extent of RPE tear. RPE = retinal pigment epithelial.
jkos-57-71f2.tif
Figure 3.
Changes in BCVA in eyes with RPE tear secondary to RAP. (A) Changes in all 14 included patients. (B) Changes in 9 patients who experienced development of RPE tear during the treatment course of RAP. ‘RPE tear’ means when the RPE tear was developed, ‘Before tear’ means 1.9 ± 1.3 months be-fore the development of RPE tear, and ‘Final visit’ means 23.7 ± 13.7 months (A) and 23.4 ± 15.3 months (B) after the de-velopment of RPE tear; Statistical analysis: (A) Repeated measures analysis of variances with Bonferroni’s correction, (B) Wilcoxon signed ranks test. BCVA = best-corrected visu-al acuity; RPE = retinal pigment epithelial; RAP = retinal an-giomatous proliferation; M = months.
jkos-57-71f3.tif
Table 1.
Baseline characteristics of patients with retinal pig-ment epithelial tear secondary to retinal angiomatous pro-liferation (n = 14)
Characteristic Data
Age (years) 75.1 ± 7.0
Sex (n, %)
  Male 3 (21.4)
  Female 11 (78.6)
Hypertension (n, %) 4 (28.6%)
Diabetes mellitus 7 (50.0%)
BCVA (log MAR) when the RPE tear was developed 1.25 ± 0.44
Foveal involvement
  Fovea-involving 4 (28.6%)
  Fovea-saving 10 (71.4%)
Grade of RPE tear*
  Grade 1 0
  Grade 2 1 (7.1%)
  Grade 3 9 (64.3%)
  Grade 4 4 (28.6%)

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviation; BCVA = best-corrected visual acuity; log MAR = logarithm of minimal angle of resolution; RPE = reti-nal pigment epithelial.

* Grading was performed based on the classification of Sarraf et al18

Table 2.
Factors associated with best-corrected visual acuity at the final visit
Factors p-value*
Age 0.637
Period between the diagnosis and the development of RPE tear 0.895
Follow-up period after RPE tear 0.402
Number of anti-VEGF injections after RPE tear 0.560
BCVA when the RPE tear was developed 0.006

RPE = retinal pigment epithelial; VEGF = vascular endothelial growth factor; BCVA = best-corrected visual acuity.

* Statistics were analyzed by Pearson correlation analysis.

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