Long-term visual outcome of pigment epithelial tears in association with anti-VEGF therapy of pigment epithelial detachment in AMD

Abstract

Purpose Retinal pigment epithelium (RPE) tears may develop as a complication after anti-VEGF (vascular endothelial growth factor) treatment for pigment epithelial detachments (PEDs) in exudative age-related macular degeneration (AMD). This retrospective study analyses best-corrected visual acuity (BCVA) and foveal involvement after RPE tears that are associated with anti-VEGF therapy due to PED in exudative AMD. Methods A total of 37 patients with RPE tears during anti-VEGF therapy (bevacizumab 12, ranibizumab 21 and pegaptanib 4 eyes) for progressive PED in AMD (PED with occult choroidal neovascularization 25 eyes and PED with retinal angiomatous proliferation 12 eyes) were included in this study. We analyzed BCVA and different morphologic aspects by means of appearance on fluorescein angiography and optical coherence tomography. Mean follow-up was 88 weeks. Results RPE tears were diagnosed a mean of 56 days after the first injection. BCVA deteriorated after RPE tear and during follow-up significantly (Po0.001), with 53.2% of eyes being legally blind (WHO, world health organization) at 12 months. RPE-free foveal area, foveal wrinkling of the RPE, and fibrotic scar development were significantly associated with worse visual acuity. Discussion RPE tears can be observed in 12-15% of treated eyes during anti-VEGF therapy for PED in exudative AMD. Owing to the close time relationship with the therapy, this complication must be taken into consideration. Visual prognosis is associated with a decrease in vision in the long term, often resulting in a severe visual disability. Relevant factors for a negative visual prognosis were the potential foveal involvement of the central RPE and morphologic fibrovascular transformation of the RPE tear.

Retinal Pigment Epithelium Tears in Age-Related Macular Degeneration Treated with Antiangiogenic Drugs: A Controlled Study with Long Follow-Up

“…Many authors have already suggested that persistent anti-VEGF therapy is important for eyes with RPE tears in order to continue the suppression of neovascular activity, mainly in cases of RPE tears sparing the fovea [14,17,25,27,28,30,33]. They coincide with our findings in the treated group, and the devastating long-term visual outcome of RPE tears without treatment described by Gutfleisch et al [26] agrees with the results obtained in our control group. Most of the patients included in the present study had no foveal involvement [30].…”

“…Gutfleisch et al [26] also suggested that the development of a fibrovascular scar can turn into a more benign form – such as atrophy of the RPE-free area – administering anti-VEGF treatment, but this is not supported by our data which show a higher trend towards developing a disciform fibrotic scar after treatment. In our opinion, final inactivity and the status of the retina at the fovea is what really matters.…”

“…Therefore, there is not much clinical guidance as to how to manage these eyes. However, since 2007 there are few reports that indicate that anti-VEFG drugs improve the outcome of this condition [18,25,26,27,28]. Here we describe a cohort of eyes treated with anti-VEGF and compare it with a control group, which can add data regarding the possible benefit of anti-VEGF therapy for this uncommon but devastating complication of wet AMD.…”

Neovascular Age-Related Macular Degeneration

“…Ranibizumab monotherapy patients gained +9.2 letters and PDT-V monotherapy patients +7.5 letters. Data from lower level clinical trials suggest that fibrovascular and serous pigment epithelium detachment, and retinal angiomatous proliferation lesions can be considered for treatment but might not respond as well as typical occult lesions [26,27]. …”

Modern views on myopic maculopathy

“…Японскими ис-следователями описан случай отслойки сетчатки, развив-шейся через 1 мес после введения ранибизумаба у пациен-та с миопической макулопатией, СНМ и макулярным от-верстием. Наиболее часто встречающимся осложнением при эндовитреальных инъекциях признано повышение внутриглазного давления [57][58][59][60][61].…”