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

Jae Hong Park; Woo Seok Choae; Hee Seong Yoon

doi:10.3341/jkos.2014.55.9.1340

Journal List > J Korean Ophthalmol Soc > v.55(9) > 1009782

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Park, Choae, and Yoon: Long-Term Observation of Retinal Pigment Epithelial Tear after Anti-VEGF Treatment for Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2014;55(9):1340-1346.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1340

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

Jae Hong Park, MD, Woo Seok Choae, 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: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: heesyoon@dreamwiz.com

Received 7 February 2014 Revised 25 March 2014 Accepted 29 August 2014

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

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.

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

References

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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.

Table 1.

Summary of cases of retinal pigment epithelium tears after anti-VEGF therapy

No.	Age (years)	Sex	Injection	No. anti-VEGF treatments (pre-/post tear)	Interval of injection to tear (days)	Followup duration (months)	RPE tear to last visit (months)	Preinjection VA	Pre-tear VA	Post-tear VA	Latest VA	Latest VA of fellow eye	Presence of wet AMD in fellow eye	Anti-VEGF of fellow eye
1	79	F	R	3/2	102	34	23	1.7	2.2	2.4	2.4	0.2	No	No
2	86	F	B	7/6	161	66	37	0.5	0.4	0.4	0.3	3.0	Yes	No
3	88	F	B	4/1	57	55	49	2	2.2	2.2	1.7	2.2	Yes	Yes
4	84	M	B	5/19	60	52	50	1	0.4	0.4	0.3	2.0	Yes	No
5	80	M	R + B	R2/R1+B6	28	30	28	0.5	1.4	1.4	1.4	0.3	Yes	Yes
6	79	F	R	1/3	27	28	27	2.7	2.4	2.4	2.4	0.1	No	No
7	78	F	R	1/0	22	22	19	1.2	1.7	1.7	3	0.4	Yes	Yes
8	81	F	R+ B	R1/R4+B8	36	25	23	1.7	1.7	1.7	1.7	1.7	Yes	Yes
9	69	M	R	1/2	20	17	16	0.2	0.2	1	2.2	2.2	Yes	Yes
10	76	F	B	4/4	36	17	16	0.3	3	3	3	0.7	No	No
11	84	M	R + B	R3/R2+B7	55	32	27	1	2.2	2.2	2.2	0.3	Yes	Yes
12	80	M	R + B	R5/B3	26	39	32	2.2	1.7	1.7	2	0.3	Yes	Yes
13	78	M	B	5/5	78	75	22	1	1	1	1	1.2	Yes	No
Mean	80.1				54.46	37.91	29.21	1.23	1.58	1.65	1.82	1.13	Y = 10	Y = 7
SD	4.83				40.20	18.66	10.98	0.78	0.86	0.80	0.88	0.99	N = 3	N = 6

VEGF = vascular endothelial growth factor; RPE = retinal pigment epithelium; VA = visual acuity (log MAR); AMD = age-related macular degeneration; R = ranibizumab; B = bevacizumb; SD = standard deviation.

Table 2.

OCT measurements of cases of retinal pigment epithelium tears after anti-VEGF therapy

No.	Preinjection PED diameter (um)	Preinjection PED height (um)	SRF	Preinjection CMT (um)	Pre-tear CMT	Post-tear CMT	latest CMT	Post-tear CME or SRF	Latest CME or SRF	Foveal sparing	Anatomic outcome
1	1560	379	Yes	359	153	231	209	Yes	Yes	No	SRF improved
2	2376	448	Yes	414	351	414	371	Yes	No	Yes	SRF improved
3	3424	644	Yes	426	239	188	198	No	No	No	Disciform scar
4	2416	464	Yes	291	224	325	228	Yes	No	Yes	SRF improved
5	3369	441	No	489	253	225	211	No	No	Yes	Persistence of SRF
6	2829	681	No	271	271	262	288	Yes	Yes	Yes	Disciform scar
7	3408	436	Yes	461	195	214	224	No	Yes	Yes	Disciform scar
8	2378	648	Yes	292	292	270	523	Yes	Yes	No	SRF improved
9	5289	721	No	246	243	240	217	Yes	Yes	No	Disciform scar
10	2160	292	Yes	283	315	340	254	No	No	NO	SRF improved
11	2753	583	Yes	290	302	212	248	Yes	No	Yes	Disciform scar
12	3697	465	Yes	231	240	242	217	Yes	No	No	SRF improved
13	2370	368	Yes	285	285	264	257	Yes	No	Yes	Disciform scar
Mean	2925.31	505.38		333.69	258.7	263.6	265.0	Y = 9	Y = 5	Y = 7
SD	936.25	135.06		85.88	52.41	62.37	89.91	N = 4	N = 8	N = 6

OCT = optical coherence tomography; VEGF = vascular endothelial growth factor; PED = pigment epithelial detachment; SRF = subretinal fluid; CMT = central macular thickness; CME = cystoid macular edema; SD = standard deviation.

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