Pigment Epithelial Tear Research Articles

Retinal pigment epithelial tear after intravitreal bevacizumab injection for exudative age-related macular degeneration.

Retinal pigment epithelial tear after intravitreal bevacizumab injection for exudative age-related macular degeneration.

PROSPECTIVE EVALUATION OF THE INCIDENCE AND RISK FACTORS FOR THE DEVELOPMENT OF RPE TEARS AFTER HIGH- AND LOW-DOSE RANIBIZUMAB THERAPY

To prospectively determine the incidence and risk factors for retinal pigment epithelial (RPE) tears in eyes with vascularized pigment epithelial detachments (PED) and exudative age-related macular degeneration receiving antivascular endothelial growth factor therapy. Eyes were prospectively randomized into 1 of 4 arms: 1) 0.5 mg of ranibizumab monthly for 12 months; 2) 0.5 mg of ranibizumab monthly for 3 months and then pro re nata on the basis of clinical and optical coherence tomography-guided indications; 3) high-dose 2.0 mg of ranibizumab monthly for 12 months; or 4) 2.0 mg of ranibizumab monthly for 3 months and then pro re nata thereafter. All PEDs were measured for height, greatest linear diameter, and surface area at baseline. The incidence of RPE tears in the entire 4-arm cohort was determined at the end of 12 months. Eyes were divided into two groups (tear vs. nontear) and statistically compared to determine risk factors for the development of RPE tear. Of 37 eyes, a total of 5 developed postranibizumab RPE tears during the course of the study (incidence 14%). Four of the 5 tears occurred in the high-dose 2.0-mg groups. Baseline PED height, surface area, and greatest linear diameter were significantly greater in the group that developed RPE tears versus the nontear group (P = 0.018, 0.031, and 0.048, respectively). There were significantly more eyes with PED height >550 microns in the RPE tear group (4 of 5, 80%) compared with the nontear group (9 of 32, 18%) (P = 0.042). The presence of PED height >550 microns was associated with an increased tear rate from 14% to 31%. Furthermore, retrospective identification of a ring sign or Grade 1 tear at baseline, in addition to PED height >550 microns, was associated with a further increase in the tear rate to 67%. In this study, the prospective incidence of RPE tears was ∼14%. A baseline PED height >550 microns and presence of a Grade 1 tear, or positive ring sign, were identified as high-risk factors for the subsequent development of an RPE tear.

Clinical manifestation of retinal pigment epithelial tear after age‐related macular degeneration treatment

AbstractPurpose To determine the risk factors for and responses of treatments after the development of retinal pigment epithelial (RPE) tears after treatment of exudative age‐related macular degeneration (AMD)Methods A retrospective, consecutive chart review was performed for all patients with exudative AMD treated with intravitreal anti‐vascular endothelial growth factor (VEGF) antibody or photodynamic therapy (PDT) between March 2010 and January 2013. The main outcome measures were time from first injection until development of RPE tear, and pre‐RPE and post‐RPE tear visual acuity. The post‐RPE tear visual acuity conservational interval was defined between the time RPE tear occurred and the time visual acuity was decreased 0.1(decimal) from pre‐RPE tear visual acuity.Results A total of 219 eyes were treated with intravitreal bevacizumab, ranibizumab or PDT. 10 eyes from 10 patients developed a RPE tear(4.6%). 3 of 10 eyes were polypoidal choroidal vasculopathy (PCV). The average RPE tear patients’ age was 75.4 years which is statistically greater than the others’(65.7 years)(p=0.001). 90%(9/10) of the RPE tears occurred within the first 12 weeks of treatment initiation. The number of patients conserving whose post‐RPE tear visual acuity was 5(50%) and their visual acuity was conserved until about 4 months. However, all 10 patients had poor visual acuity within 1 year follow‐up period.Conclusion RPE tears can occur after treatments for exudative AMD in more elder patients. Visual acuity could be conserved at early period after RPE tear occurred. However, visual acuity finally decreased within 1 year in spite of continuous treatment.

Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme

PurposeEvaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice.MethodsThe LUMINOUS programme comprises a prospective observational study assessing ranibizumab ‘real-world’...

Prediction of retinal pigment epithelial tear in serous vascularized pigment epithelium detachment

The aim of the study was to identify predictive factors for detection of impending retinal pigment epithelium (RPE) tears in patients under anti-VEGF therapy for treatment of retinal pigment epithelial detachment (PED) due to exudative age-related macular degeneration (AMD) using near-infrared reflectance imaging (NIR), spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FLA). We retrospectively evaluated NIR, SD-OCT and FLA images, number of intravitreal injections as well as demographical data of 103 eyes of 98 patients with vascularized PED [48.5% fibrovascular PED (fPED), 51.5% serous vascularized PED (svPED)] secondary to AMD. Fifteen eyes with svPED of 103 included eyes (14.6%) developed an RPE tear under anti-VEGF therapy. Prior to RPE tear formation, we could identify radial hyperreflective lines spreading in a funnel-like pattern across the PED lesion in NIR images in 11 eyes correlating with folds in the RPE on corresponding SD-OCT scans (mean observation period: 115.4 ± 66.6 days; mean number of injections: 3.2 ± 1.5; mean PED height 828.2 ± 356.5 μm). In nine RPE tears (81.8%), the edge of the tear could be clearly localized on the opposite side of the PED lesion in relation to the origin of hyperreflective lines. None of the fPED patients showed the described signal. Patients under anti-VEGF therapy for treatment of svPED due to AMD frequently show radial hyperreflective lines in NIR images prior to RPE tear development that correspond to wrinkled changes in the RPE. Hyperreflective lines may serve as an indicator for an impending RPE tear in svPED patients.

Effect of ranibizumab on serous and vascular pigment epithelial detachments associated with exudative age-related macular degeneration

PurposeTo report the effect of intravitreal ranibizumab therapy for serous and vascular pigment epithelial detachments (PED) associated with choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD).MethodsIn a prospective study, best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were collected for 62 eyes of 62 patients, with serous or vascular PED associated with CNV secondary to AMD. Intravitreal ranibizumab 0.5 mg was administered with a loading phase of three consecutive monthly injections, followed by monthly review with further treatment, as indicated according to the retreatment criteria of the PrONTO study. The change in visual acuity and PED height from baseline to month 12 after the first injection was determined.ResultsSixty-one eyes of 61 patients (one of the patients developed retinal pigment epithelial tear and was excluded from the study) were assessed at the 12-month follow-up examination. There were two types of PED, including vascular PED in 32 patients (Group A) and serous PED (Group B) in 29 patients. The mean improvement of mean BCVA from baseline to 12 months was 0.09 logMAR (Logarithm of the Minimum Angle of Resolution) in Group A and 0.13 logMAR in Group B. Both groups showed significant improvement of the mean BCVA 12 months after the first injection compared with the baseline value (P < 0.05). In relation to the PED height, the mean decrease of mean PED height from baseline to 12 months was 135 μm in Group A and 180 μm in Group B. Both groups showed significant reduction of the PED height during the follow-up period (P < 0.01). The PED anatomical response to ranibizumab was not correlated with the BCVA improvement in any of the groups. Apart from one patient who developed pigment epithelial tear no other complications were documented.ConclusionRanibizumab is an effective and safe treatment for improving vision in patients with serous and vascular PED, although the anatomical response of the PED to ranibizumab may not correlate directly with the visual outcome.

Anti-VEGF response in macular hemorrhage and incidence of retinal pigment epithelial tears

ObjectiveTo study the visual and anatomic outcomes of serial anti–vascular endothelial growth factor (anti-VEGF) therapy for severe macular hemorrhage in eyes with exudative age-related macular degeneration (AMD). DesignConsecutive retrospective analysis. ParticipantsTwenty eyes from 20 patients with severe macular hemorrhage (greater than 50% blockage with formal fluorescein angiography [FA]) secondary to wet AMD were studied. MethodsWe performed a chart review of patients at a single centre from May 2006 to September 2009. Presenting visual acuity and diameter of hemorrhage were recorded as well as number of injections, time by which no hemorrhage was remaining, and final anatomic outcome. Cardiovascular risk factors and use of antiplatelet medication or anticoagulation were noted. ResultsAverage presenting visual acuity was 1.55 (20/710), and number of injections needed for resolution of hemorrhage was 4. Visual acuity significantly improved from 1.55 (20/710) to 0.70 (20/100) after injections. Thirty-five percent of eyes were found to have an associated retinal pigment epithelial (RPE) tear, and these eyes were found to have received more injections. Final visual acuity was not significantly different in eyes with RPE tears compared with nontear eyes. Eighty-one percent of patients had associated cardiovascular risk factors; antiplatelet therapy and anticoagulation were not found to play a role in hemorrhage size. ConclusionsRPE tears are found in a significant number of individuals with large macular hemorrhages secondary to exudative macular degeneration, but with continued treatment with anti-VEGF therapy, visual acuity can significantly improve even in the presence of these tears. Eyes with severe macular hemorrhage thus should be considered candidates for anti-VEGF therapy.

Retinal pigment epithelial detachments and tears, and progressive retinal degeneration in light chain deposition disease

Background/purposeLight-chain deposition disease (LCDD) is a rare condition characterised by deposition of monoclonal immunoglobulin light chains (LCs) in tissues, resulting in varying degrees of organ dysfunction. This study reports the...

LONG-TERM RESULTS OF REPEATED ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN EYES WITH RETINAL PIGMENT EPITHELIAL TEARS

To evaluate the long-term results of retinal pigment epithelium tears in eyes treated with repeated anti-vascular endothelial growth factor (VEGF) therapy. Five patients with retinal pigment epithelial tears (without foveal center involvement) after anti-VEGF injection were studied retrospectively. Mean follow-up time was 52 months, with measurements of visual acuity and evaluation of macular findings by angiography and optical coherence tomography during this period. All eyes had a persistent submacular neovascular membrane 30 days after the tear. An anti-VEGF drug was reinjected until the membranes stopped leaking. The mean initial visual acuity immediately after the tear was 20/160, and the mean final visual acuity was 20/60. The number of anti-VEGF reinjections varied from two to eight during the follow-up period. Long-term optical coherence tomography analysis showed reduced fluid and remodeling of the torn retinal pigment epithelium. Long-term visual results with repeated anti-VEGF therapy are not as devastating as suggested previously. Visual acuity and metamorphopsia improve with time as long as the neovascular membrane is inactive. Optical coherence tomography changes in the macular area reflect the visual acuity improvement.

Bilateral retinal pigment epithelium tears in acute Vogt-Koyanagi-Harada disease.

To report an original case of retinal pigment epithelial (RPE) tears in acute Vogt-Koyanagi-Haradadisease. Observational case report of a patient who presented with RPE tears in acute Vogt-Koyanagi-Harada disease, who underwent clinical examination, fluorescein and infracyanine green angiographies, and optical coherence tomography evaluation. A 42-year-old woman presented with bilateral serous retinal detachment related to Vogt-Koyanagi-Harada disease. Eight days after high-dose systemic corticosteroids, she developed bilateral RPE tears. At the 15-month follow-up, visual acuity was 20/20 in both eyes. The RPE tears are rarely observed in acute Vogt-Koyanagi-Harada disease. The RPE tears were likely caused by acute inflammation of the choroidal stroma.

Bimonthly half-dose ranibizumab in large pigment epithelial detachment and retinal angiomatous proliferation with high risk of retinal pigment epithelium tear: a case report

IntroductionThe management of large pigment epithelial detachments (PEDs) associated with retinal angiomatous proliferation (RAP) remains a challenge due to the high risk of retinal pigment epithelial (RPE) tear. We describe the successful progressive anatomical result and the maintenance of visual acuity to bimonthly, half-dose ranibizumab in a patient with this condition.PurposeTo describe the management of a large PED secondary to RAP with bimonthly, half-dose ranibizumab.MethodCase report.PatientA 71-year-old woman presented with visual symptoms due to an enlarged PED, compared with previous visits, secondary to a RAP lesion, with a visual acuity of 20/32. To reduce the risk of an RPE tear and a significant decrease in vision, we discussed with the patient the possibility of treating the lesion in a progressive manner, with more frequent but smaller doses of ranibizumab. The patient was treated biweekly with 0.25 mg of ranibizumab until fattening of the PED.ResultsThe large PED fattened progressively, and visual acuity was preserved with no adverse events.DiscussionThe use of half-dose antiangiogenic therapy may be useful in managing large vascularized PED associated with RAP, in an attempt to reduce the risk of RPE tear.

Clinical Manifestation of Retinal Pigment Epithelial Tear after Treatment of Age-Related Macular Degeneration

Clinical Manifestation of Retinal Pigment Epithelial Tear after Treatment of Age-Related Macular Degeneration

3D spectral domain OCT in spontaneous retinal pigment epithelial tear

IntroductionNeovascular age-related macular degeneration is character-ized by the presence of the choroidal neovascularizationmembrane (CNVM) and is associated with pigment epithe-lial detachment (PED) [1]. RPE tears are a serious compli-cation that can follow PED [2–6]. Fibrovascular contractionof choroidal neovascular membranes, mechanical forcesfrom vitreomacular traction, or interruption of tight junc-tions due to anti-VEGF therapy are the most probablecauses [5]. The RPE tear creates an area where photorecep-tors have no RPE support. If the fovea lies within the RPE-denuded area, a marked decrease in visual acuity is ob-served, often accompanied by eccentric fixation [7].Materials and methodsTheauthorsconfirmadherencetothetenetsoftheDeclarationof Helsinki. After taking a written informed consent, spectraldomain optical coherence tomography (SD-OCT) [Cirrushigh-definition OCT (Carl Zeiss Meditec Inc.), CA, USA]was performed in two cases of spontaneous retinal pigmentepithelium (RPE) tear in neovascular age-related maculardegeneration (AMD). 3D SD-OCT has been used for the firsttime for documenting an RPE tear in neovascular AMD.Case report 1—A 57-year-old female presented at ourtertiary center with the chief complaint of gradual progres-sive diminution of vision in both eyes since 5 years withrecent diminution of vision in the left eye since 10 days.Vision in the right eye was 20/60 and that in the left eye wasfinger counting 5 m. On slit lamp biomicroscopic examina-tion, the anteriorsegment was found to be unremarkable.Onfundus examination, the right eye showed retinal pigmentepithelial alteration in the macula. The left eye showed alarge crescentric RPE tear in the macular area with barechoroid above and rolled-up RPE below (Fig. 1). Fluores-cein angiography showed a crescent-shaped area ofhyperfluorescence corresponding to a bare choroid with anarea of hypofluorescencebelow itcorrespondingto reflectedRPE (Fig. 2).On advanced visualization of the macula, SD-OCTof theright eye revealed retinal pigment epithelial detachment. Ahyperreflective area of RPE with loss in its continuity waspresent at the edge of PED in the left eye (Fig. 3). The areaof the tear showed greater reflectivity and thickness ascompared to the rest of the RPE and extended in thesubretinal space. 3D SD-OCT precisely showed the RPEtear with hyperreflective dusting present around it (Fig. 4).Follow-up visit after 2 months showed marked changeson SD-OCT. Thickness of the hyperreflective RPE in-creased markedly with loss of its integrity (Fig. 5). Thesub-RPE space was obliterated with both hyperreflectiveand moderately reflective material representing the choroi-dal neovascular membrane (Fig. 5). Advanced visualizationof the area of bare choroid guided by scanning laser oph-thalmology exquisitely showed the presence of CNVM withthe absence of RPE (Fig. 6). 3D SD-OCT showed a signif-icant increase in hyperreflective dusting surrounding thearea of the tear (Fig. 7).Casereport2—A78-year-oldmalepresentedwithgraduallyprogressive diminution in both eyes for 7 years. Vision in the

Recovery of retinal pigment epithelium correlating with restoration of retinal sensitivity in eyes with a retinal pigment epithelial tear

Recovery of retinal pigment epithelium correlating with restoration of retinal sensitivity in eyes with a retinal pigment epithelial tear

CAUSES OF UNSUCCESSFUL RANIBIZUMAB TREATMENT IN EXUDATIVE AGE-RELATED MACULAR DEGENERATION IN CLINICAL SETTINGS

To identify the causes of loss of vision after ranibizumab therapy in patients with exudative age-related macular degeneration treated in three clinical settings. A retrospective multicentric analysis of 290 consecutive eyes comprising cohorts from 3 clinical settings showed that 21 eyes lost ≥ 15 letters on the Early Treatment Diabetic Retinopathy Study chart 1 year after the start of ranibizumab treatment. Fundus images of these eyes were analyzed by two independent readers to investigate the causes of visual loss. The three cohorts were compared. A search was made for factors predisposing to visual loss. A second analysis was performed to compare the baseline characteristics of patients who gained (visual acuity gainers) or lost (visual acuity losers) ≥ 15 letters. Among the 290 eyes included, the proportions from each center experiencing visual loss were not significantly different (mean, 7.24%, P = 0.2631). Mean visual loss of affected eyes was 27 letters. There was no significant difference between these eyes and others as regards age and gender of patients, laterality, type of choroidal neovascularization, number of visits, or initial visual acuity. Visual loss was secondary to the progression of atrophy in eight eyes, fibrosis in five eyes, a combination of fibrosis and atrophy in three eyes, severe subretinal hemorrhage in three eyes, and retinal pigment epithelial tear in two eyes. A significant difference between visual acuity gainers and losers was observed for 2 parameters: age of patients, 80.9 ± 5.3 years in visual acuity losers versus 77.5 ± 7.3 years in visual acuity gainers (P = 0.0473) and visual acuity at diagnosis, respectively, 56.2 ± 11.2 versus 49.0 ± 12.0 (P = 0.0288). Although uncommon, visual loss may occur during ranibizumab treatment and is because of the natural course of age-related macular degeneration in most cases.

Incidence of retinal pigment epithelial tears after intravitreal bevacizumab injection for neovascular age‐related macular degeneration

AbstractPurpose To determine the incidence of and the risk factors for the development of retinal pigment epithelial (RPE) tears after intravitreal bevacizumab injection (IVB) for the treatment of exudative AMD.Methods A retrospective, consecutive case series of all patients with subfoveal exudative AMD treated with IVB between September 2006 and April 2012. The main outcome measures were pre‐ and post‐RPE tear visual acuity and choroidal neovascular membrane lesion types, incidence of tears and time from first injection until development of the tear.Results A total of 369 patients (643 eyes) with exudative AMD were treated with IVB. 9 eyes from 7 patients developed a RPE tear for an incidence of 1.4%. The average patient age was 62.4+/‐3.9 years. A vascularized PED was present in 7 of 9 eyes that developed an RPE tear. 44.44 per cent of the RPE tears occurred within the first 6 weeks of treatment, and all tears occurred within the first 24 weeks of treatment initiation. The mean pre‐injection visual acuity was +0.6 logMAR with a mean post‐tear visual acuity of +1 logMAR. 4 of the 9 eyes continued with bevacizumab injections after tear development, and 2 of these 4 eyes continued to have visual improvement.Conclusion RPE tears occur after intravitreal bevacizumab injections for exudative AMD in approximately 1.4% of eyes and can cause severe vision loss. Maintenance of therapy may help preserve quality of vision after RPE tear development.

Three-year visual and anatomic results of administrating intravitreal bevacizumab in inflammatory ocular neovascularization

ObjectiveTo assess the 3-year visual outcome of intravitreal bevacizumab in inflammatory ocular neovascularization. DesignExperimental study. MethodsRetrospective multicenter consecutive case series in 81 patients with inflammatory ocular neovascularization refractory to standard therapy and treated with intravitreal bevacizumab. The outcome measures included improvement of best corrected visual acuity expressed as logarithm of minimum angle of resolution (logMAR) and paired comparison decrease in central foveal thickness by optical coherence tomography. ResultsMean best corrected visual acuity improved from baseline 0.699 (6/30 or 20/101) (SD 0.434) to 0.426 (6/16 or 20/53) (SD 0.428) (n = 81; p < 0.001), a gain of 2.7 lines (median 3 injections; 81 eyes; 81 patients). Paired comparisons revealed significant central foveal flattening at 3 years of 97.9 μm (n = 51; p < 0.001). In a subgroup analysis, visual improvement was significant for ocular histoplasmosis (p = 0.026); multifocal choroiditis (p = 0.05); serpiginous choroiditis (p = 0.028); ocular toxoplasmosis (p = 0.042); and punctate inner choroidopathy (p = 0.015). In a subgroup analysis, foveal flattening was significant for ocular histoplasmosis (p = 0.004); multifocal choroiditis (p = 0.007); serpiginous choroiditis (p = 0.011); and punctate inner choroidopathy (p = 0.001). Of the group, 5 eyes developed submacular fibrosis, 1 eye retinal pigment epithelial tear, and 1 eye macular ischemia in the context of vasculitis. ConclusionAt 3 years, intravitreal bevacizumab sustained significant visual improvement of 2.7 lines and significant foveal flattening of 98 μm in a wide variety of inflammatory ocular diseases without major complications after a median of 3 injections.

This issue of Acta, printed and electronic

This issue of Acta, printed and electronic

The Importance of Informed Consent in Patients with Wet Age-related Macular Degeneration considering Intravitreal Anti-vascular Endothelial Growth Factor Treatments

Retinal pigment epithelial (RPE) tears are now a documented potential complication following the intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatments for neovascular age-related macular degeneration. Patients are often not well consented regarding this risk and thus we retrospectively analyzed the data from all of our patients undergoing this treatment over a six month period. Our findings highlighted the fact that the three patients (out of thirty) who had developed this RPE tear complication were initially all diagnosed with a pigment epithelial detachment (which is a type of macular degeneration in question). Therefore, we have adjusted our informed consent procedure such that all patients with "wet" macular degeneration and especially those with pigment epithelial detachments are now fully consented regarding the risks of the intravitreal treatment, which could potentially damage their vision further.

Retinal pigment epithelial tears following ranibizumab therapy for fibrovascular retinal pigment epithelial detachment due to occult age-related macular degeneration

SummaryBackgroundThe aim of this paper is to report the incidence of retinal pigment epithelial (RPE) tears in patients treated with ranibizumab for subfoveal fibrovascular retinal pigment epithelial detachment (FVPED) due to occult age-related macular degeneration (AMD).Material/MethodsThirty patients were treated according to the following schedule: saturation phase, further treatment was based on activity of the degeneration process. Visual acuity (VA), optical coherence tomography (OCT) and fluorescein angiography (FA) parameters were evaluated and compared.ResultsPatients had a mean improvement of +4.7±8.1 letters at month 12. The mean number of needed injections was 6.8±1.8 (range, 3 to 9). RPE tears in fovea occurred in 8 cases (27% of all patients). Analysis of variance revealed significant upper mean values of ETDRS letters for the subgroup without RPE tears. Mean values of PED height were significant upper for RPE tears without baseline. Statistical analysis revealed that in the subgroup without RPE tears mean values of VA significantly differed in succeeding periods compare to baseline (P<0.001). Visual improvement or stabilization was observed in 90.9% of patients without RPE tears (significant improvement of 15 or more letters in 22.7%–5/22) and in 87.5% of patients with RPE tears (significant improvement was not observed). Baseline leakage parameters, lesion and leakage parameters at month 12 were significantly higher in patients with RPE tears. The chi-square test revealed statistically significant associations between RPE tears and subretinal fluid in OCT (P<0.05) at month 12.ConclusionsIn eyes with FVPED and RPE tears treated with ranibizumab, stabilization of visual acuity without significant improvement is predictable. One of the risk factors common to RPE tears may be baseline leakage parameters and pretreatment distorted RPE contour in OCT. During ranibizumab therapy in eyes with RPE tears, upper parameters of FVPED height may occur without significant differences in fovea and macula volume compare to eyes without RPE tears.