Can the risk of retinal pigment epithelium tears after bevacizumab treatment be predicted? An optical coherence tomography study

Abstract

Background Retinal pigment epithelium (RPE) tears after bevacizumab treatment for neovascular age-related macular degeneration accompanied by a pigment epithelial detachment (PED) might be caused by stretching forces on the already weakened RPE. The purpose of this study was to evaluate whether simple measurements of optical coherence tomography (OCT) can predict the individual risk of an RPE tear in preoperative candidates. Methods A retrospective chart review study of 393 consecutive patients with neovascular agerelated macular degeneration evaluated OCT images (Stratus-OCT Zeiss, Jena, Germany). The height of the PED, the central retinal thickness, and the maximum retinal thickness were determined by two independent observers and retrospectively analysed. Results Fifteen patients with an RPE tear had a significant higher PED than the remaining study population. In contrast, no correlation was seen with the central retinal thickness. In a linear regression model, the probability of an RPE tear exponentially increased in dependence of the extent of PED. Conclusion The risk of an RPE tear can be estimated by simple measurement of the height of the PED on OCT.

Change in vision after retinal pigment epithelium tear following the use of anti-VEGF therapy for age-related macular degeneration

“…This is reflected in the incidence of RPET following the use of anti-VEGF agents for all forms of AMD ranging from 0.61 % to 5.4 % [3,4,8,[10][11][12], with this range rising to a higher incidence of 5-17 % in eyes with a PED [3,6,11,13]. The data from this study also reflect this trend with 12 (85.7 %) of the RPETs occurring in patients with pre-existing PED with only two (14.3 %) of the pre-existing lesions being CNVMs without a PED.…”

“…Nonetheless, the apparent higher incidence of RPET in the setting of PED has driven interest to determine the factors that may help to predict RPET. Recent papers suggest that the greater area of the PED [11], the larger the height of the PED [6,11,13], the presence of sub-retinal fluid [11,13], serous PED [7], and a short duration of PED [28] each predict a higher frequency of RPET.…”

“…Since this time, it has been reported in the setting of a number of pathologies including: neovascular age-related macular degeneration (AMD) with and without retinal pigment epithelium detachment (PED) [2][3][4][5][6][7][8][9][10][11][12][13]; presumed ocular histoplasmosis (POH) [14]; pathologic myopia [15]; angioid streaks [16]; central serous chorioretinopathy [17]; and trauma [18]. The occurrence of RPET has been described both before and after the use of various treatment modalities, but most recently attention has focused on the association between the use of anti-vascular endothelial growth factor (anti-VEGF) agents and the formation of RPET [19][20][21][22].…”

Retinal Pigment Epithelium Tears: Risk Factors, Mechanism and Therapeutic Monitoring

“…Doguizi and Ozdek [19] statistically determined that 580 µm may be regarded as a cut-off point of PED height for the risk of an RPE tear. Similarly, Sarraf et al [39] described a height of 550 µm as a high-risk factor for the subsequent development of an RPE tear, and, additionally, Leitritz et al [40] described an increasing probability of RPE tears particularly beyond the height of 400 µm. Moreover, Chiang et al [20] hypothesised that an increased surface area as well as a large linear diameter of a subfoveal PED represent predisposing factors for RPE tear development (fig.…”

Desgarros del epitelio pigmentario de la retina: factores de riesgo, mecanismo y control terapéutico

“…Doguizi y Ozdek [19] determinaron de forma estadística que 580 μm se podía considerar un umbral de altura del DEP para que exista riesgo de que se produzca un desgarro del EPR. De manera similar, Sarraf et al [39] describieron una altura de 500 μm como factor de riesgo para el posterior desarrollo de un desgarro del EPR; de forma adicional, Leitritz et al [40] describieron que resultaría más probable de que se produjeran desgarros del EPR por encima de los 400 μm de altura. Además, Chiang et al [20] hipotetizaron que un aumento del área de la superficie y un gran diámetro lineal de un DEP subfoveal representan factores pronósticos para el desarrollo de un desgarro del EPR ( fig.…”