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

Woo Seok Choae; Jae Hong Park; Woo Seok Lee; Sang Won Kim; Hee Seong Yoon

doi:10.3341/jkos.2013.54.10.1546

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Choae, Park, Lee, Kim, and Yoon: Risk Factors for Retinal Pigment Epithelium Tears after Anti-VEGF Agent Injection in Age-Related Macular Degeneration

Original Article

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

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1546

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

Woo Seok Choae, MD, Jae Hong Park, MD, Woo Seok Lee, MD, Sang Won Kim, MD, Hee Seong Yoon, MD

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Hee Seong Yoon, MD, Sungmo Eye Hospital, #409-1 Haeun-daero, Haeundae-gu, Busan 612-823, Korea, Tel: 82-1600-0775, Fax: 82-51-743-0776, E-mail: heesyoon@dreamwiz.com

Received 29 March 2013 Revised 28 August 2013 Accepted 1 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 μm in the tear group and 2250.23 ± 988.49 μm in the control group (p = 0.027). PED height was 507.09 ± 153.97 μm in the tear group and 353.23 ± 199.42 μm in the control group (p = 0.010). CMT was 431.64 ± 200.33 μm in the tear group and 289.95 ± 61.27 μm 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.

Keywords: Bevacizumab, Intravitreal injection, PED, Ranibizumab, RPE tear

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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.

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.

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).

Table 1.

Charicteristics of 11 patients with RPE tear after treatments

Age	Sex	OD/OS	antiVEGF	No. of Injections	Pre-tearVA	After- tear VA	CMT(μm)	PED diameter (μm)	PED height (μm)	SRF
79	F	OS	Ranibizumab	3	0.02	FC20	359	1560	379	+
86	F	OD	Bevacizumab	5	0.3	0.4	414	2376	448	+
88	F	OD	Bevacizumab	1	FC50	FC30	426	3424	644	+
84	M	OD	Bevacizumab	1	0.1	0.4	291	2416	464	+
89	M	OS	Ranibizumab	5	0.1	0.04	989	2898	205	−
80	M	OS	Ranibizumab	2	0.3	0.04	489	3369	441	−
79	F	OD	Ranibizumab	1	FC10	FC20	347	2829	681	−
82	M	OS	Ranibizumab	2	0.04	0.2	434	2816	511	+
78	F	OD	Ranibizumab	1	0.06	0.02	461	3408	436	+
81	F	OD	Ranibizumab	1	0.02	0.02	292	2378	648	+
69	M	OD	Ranibizumab	1	0.6	0.1	246	5289	721	−

VA = visual acuity, PED = pigment etithelial detachment; CMT = central macular thickness; SRF = subretinal fluid.

Table 2.

Comparison of characteristics between tear group and control group treated with anti-VEGF intravitreal injection

	Tear group	Control group	p-value^*
Age (years)	81.36 ± 5.55	74.82 ± 5.28	0.003
Sex (M/F)	5/6	12/10	0.628
OD / OS	7/4	13/9	0.804

Values are presented as mean ± SD.

^* Mann-Whitney test.

Table 3.

Comparison of visual acuities between groups before and after the treatment

	Tear group	Control group	p-value^†
Pre-treatment	1.26 ± 0.74^*	1.12 ± 0.79^*	0.687
Post-treatment	1.43 ± 0.74^*	0.91 ± 0.69^*	0.058

Values are presented as mean ± SD.

^* log10 MAR;

^† Mann-Whitney test.

Table 4.

In the tear group, changes of visual acuity before and after the tear

	VA (log MAR)
Pre-tear	1.36 ± 0.78^*
Post-tear	1.43 ± 0.74^*
p-value^†	0.160

Values are presented as mean ± SD.

VA = visual acuity.

^* log10 MAR;

^† Wilcoxon signed rank test.

Table 5.

Comparisons between tear group and control group on OCT findings

	Tear group	Control group	p-value^*
PED diameter (μm)	2978.45 ± 947.69	2250.23 ± 988.49	0.027
PED height (μm)	507.09 ± 153.97	353.23 ± 199.42	0.010
CMT (μm)	431.64 ± 200.33	289.95 ± 61.27	0.005
SRF (+/-)	7/4	16/6	0.598

Values are presented as mean ± SD.

PED = pigment etithelial detachment; CMT = central macular thickness; SRF = subretinal fluid.

^* Mann-Whitney test.

Table 6.

Comparisons between tear group and control group about PED and CNV size on FAG image

	Tear group	Control group	p-value^*
PED area (mm²)	19.87 ± 18.35	8.87 ± 18.35	0.061
PED GLD (mm)	4.88 ± 2.70	3.41 ± 1.41	0.093
CNV area (mm²)	2.75 ± 3.50	1.12 ± 1.80	0.061
CNV GLD (mm)	1.74 ± 1.28	1.17 ± 0.68	0.086
CNV/PED (area)	0.19 ± 0.20	0.18 ± 0.21	0.730
CNV/PED (GLD)	0.46 ± 0.30	0.38 ± 0.18	0.579

Values are presented as mean ± SD.

PED = pigment epithelial detachment; GLD = greatest linear dimension; CNV = choroidal new vessel.

^* Mann-Whitney test.

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