Clinical Associations and Prognostic Implications of Repair Tissue Proliferation in Eyes With Retinal Pigment Epithelium Tears

Abstract

Purpose: To investigate demographic and clinical factors influencing the longitudinal changes of retinal pigment epithelium (RPE) dehiscence area after RPE tears, including the presence of RPE tear-associated repair proliferation (TARP), and identify factors associated with TARP development over follow-up.Methods: Retrospective, single-center, observational cohort study of patients with a history of macular neovascularization and RPE tear. The area of RPE dehiscence was measured on repeated short-wavelength fundus autofluorescence imaging. Associations between covariates and RPE dehiscence areas were tested with multivariable linear mixed models. Associations between TARP development and clinical variables were investigated with Cox regression models. Factors associated with visual acuity changing rates were explored with linear mixed models.Results: Thirty-seven eyes of 36 patients were included in this study and followed for a median time of 18 months. Tear-associated repair proliferation was identified in 27 eyes (73%). The median time for TARP detection was 112 days; none of the investigated factors was significantly associated with TARP occurrence. The presence of TARP (estimate: 20.042 mm 2 /month; P = 0.001) and female gender (estimate: 20.035 mm 2 /month; P = 0.006) were associated with slower rates of RPE dehiscence enlargement over time. Faster rates of visual improvement were observed in eyes with TARP compared with those without TARP (estimate = 20.010 logarithm of the minimum angle of resolution/month if TARP was present; P = 0.008).Conclusion: Retinal pigment epithelium tear repair with TARP and female gender were associated with slower RPE degeneration after RPE tears. The presence of TARP was associated better visual prognosis. Additional research on factors promoting TARP development may have therapeutic and prognostic implications.

Change in Choriocapillaris Flow Deficits Within Tears of the Retinal Pigment Epithelium Imaged With Swept-Source Optical Coherence Tomography Angiography

“…Moreover, it has been postulated that in patients with RPE tears and persistent subretinal fluid in the exposed area, the RPE from the edge of the tear may be able to reproliferate, repair the region, and improve visual prognosis, but this reproliferating RPE may be undetectable by routine OCT imaging. [25][26][27] It has also been proposed that those patients without subretinal fluid had worse visual outcomes because the outer retina attached directly onto the exposed Bruch membrane where the RPE was lost, resulting in loss of photoreceptors. [25][26][27] In our cases, this reproliferating RPE may be present on B scans in which the hyperreflective bands and an intact photoreceptor layer become apparent in the region where the RPE was supposedly lost (white arrows Figure 1, H and I, Figure 2, E and F, Figure 3, E and F).…”

“…[25][26][27] It has also been proposed that those patients without subretinal fluid had worse visual outcomes because the outer retina attached directly onto the exposed Bruch membrane where the RPE was lost, resulting in loss of photoreceptors. [25][26][27] In our cases, this reproliferating RPE may be present on B scans in which the hyperreflective bands and an intact photoreceptor layer become apparent in the region where the RPE was supposedly lost (white arrows Figure 1, H and I, Figure 2, E and F, Figure 3, E and F). Specifically, in Case 2, the en face structural image seems to show a brighter area that changes as the configuration of the hyperTD evolves at the final follow-up visit (Figure 2, B and C).…”

Multimodal Imaging and Microperimetry of Retinal Pigment Epithelium Tear-Associated Resurfacing Tissue

“…T he pathogenesis and clinical significance of the tissue resurfacing the denuded Bruch membrane after retinal pigment epithelium (RPE) tears in neovascular age-related macular degeneration (nAMD) are poorly understood. 1 In addition, correlations between multimodal imaging of healing RPE tears and functional outcomes remain controversial. 2,3 We report the morphofunctional correlation of the resurfacing tissue secondary to a RPE tear in nAMD, including high-resolution optical coherence tomography (High-Res OCT, SPECTRALIS, Heidelberg Engineering, Heidelberg, Germany) and microperimetry.…”