Retinal pigment epithelial (RPE) tears after serous pigment epithelial detachment (PED) in wet AMD: A retrospective study of 23 patients

Abstract

AbstractPurpose: Age‐related macular degeneration (AMD) is one of the main causes for vision impairment. Pigment epithelial detachment (PED) is a common finding, which in its serous form is associated with wet AMD. PED can lead to retinal pigment epithelial (RPE) tears, which are associated with a further loss in vision. One known risk factor for RPE ruptures is the use of anti‐VEGF injections in patients with persisting PED. The aim of our study was to identify morphological parameters in the SD‐OCT that could present risk factors for RPE tears. Furthermore, this study aims at helping to predict functional and morphological outcomes for patients with RPE tears associated with PED in AMD.Methods: All patients in the database of Vista Augenklinik Binningen, Switzerland, diagnosed with RPE tears in SD‐OCT were included. Patients who presented with RPE tears at their first consultation were excluded from the study. Both morphological factors in imaging (SD‐OCT, FAF), as well as the history of anti‐VEGF injections prior and after the RPE tears occurred, were retrospectively analysed.Results: 23 eyes of 23 patients (57% females) were included. At the time of the RPE tear, the mean age was 81.9 ± 13.1 years (range: 70–95 years, median: 83 years). Mean follow‐up time was 28.7 ± 31 months (range: 1–52 months) after the rupture. The mean height of PED was 324.5 μm (range: 24‐837 μm) at the first consultation. In 6 out of 7 patients (86%) with initial PED height > 526 μm, an RPE rupture occurred between the first and second consultation. 4 out of those 6 patients (67%) had received their first anti‐VEGF injection. Only 2 out of the other 16 patients (12%) with PED ≤375 μm had a rupture between the first and second consultation. The mean PED height in the last OCT imaging before rupture was 563 ± 486.55 μm (range: 121‐1039 μm). 8 patients (35%) had received exactly one anti‐VEGF injection before the rupture (mean height before rupture: 580,5 μm), another 8 patients (35%) received more than one injection (range: 2–55, mean height before rupture: 589,1 μm) and 7 patients (30%) did not receive anti‐VEGF injections (mean height before rupture: 513.1 μm).Conclusions: The risk of RPE tears should be considered when treating patients with PED in wet AMD. Further studies with larger sample sizes should be encouraged in addition to the existing scores.