Long-Term Results of Repeated Anti–vascular Endothelial Growth Factor Therapy in Eyes With Retinal Pigment Epithelial Tears

Abstract

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.

Anatomical and visual outcomes of ranibizumab injections in retinal pigment epithelium tears

“…Moreover, it has been demonstrated that the precipitates in the su bretinal outer segment layer acted as hyperreflective spots in OCT ophthalmoscopy of central serous retinopathy (18,19) . Previous studies have reported repopulation and reattachment of RPE cells after tear formation, but these studies did not demonstrate healing of the hypoautofluorescence in the tear region (2,8) . Pece et al used OCT to show that reattachment of the margins of an RPE tear were healed by tissue remodeling and described how the disease can recur (20) .…”

“…After RPE tear formation, the PED usually becomes flat spontaneously. Reattachment of the free RPE edges to the Bruch membrane at a different location has recently been reported (2) . There is a possibility of improvement in patients with lower grade RPE tears (12) .…”

“…RPE tears usually develop from the temporal edge of the PED. The separated part of the RPE folds parallel to the PED and reveals the bare Bruch's membrane for a few days (2,8,12) . After RPE tear formation, the PED usually becomes flat spontaneously.…”

“…RPE tears may develop spontaneously in eyes with AMD or after photocoagulation and photodynamic therapy. There are also cases reported to occur after nd:YAG laser capsulotomy and cataract surgery (2)(3)(4) . After anti-vas cular endothelial growth factor (VEGF) therapies became widely used for cho roidal neovascularization, the incidence of RPE tears has increased recently (5)(6)(7) .…”

“…A deep hyperreflectivity under the line corresponding to the RPE is evident in the area of the bare choroid. Fundus autofluorescence shows patchy or hazy hyperfluorescence (1)(2)(3)(4)(5)(6)(7)(8) . The incidence of RPE tear formation following anti-VEGF treatment has been reported to range between 1.8% and 27% in recent studies (9) .…”