Optical coherence tomography features of the repair tissue following RPE tear and their correlation with visual outcomes

Abstract

To assess the optical coherence tomography (OCT) features of the repair tissue after retinal pigment epithelial (RPE) tear in neovascular age-related macular degeneration. Retrospective, observational study. Medical and imaging records of patients that developed tears after starting anti-VEGF treatment and with at least 12 months of follow-up were reviewed. OCT reflectivity of the RPE-subretinal hyperreflective tissue (SHT) complex was measured at 6, 12 and 18 months (when available). Reflectivity of the adjacent unaffected RPE-Bruch’s membrane was taken as internal reference. Other variables: grade and rip occurrence (early/late); number of intravitreal injections; type of macular neovascularization; sub-macular hemorrhage (SMH) at onset. Forty-nine eyes (age: 76.1 ± 7.0 years; VA: 0.54 ± 0.27 LogMAR) were included. Thirty-eight eyes had OCT signs of healing during the follow-up, with 21 showing SMH at baseline. Final VA positively correlated with the number of injections and negatively correlated with the RPE-SHT reflectivity and the presence of SMH (p < 0.001). Reflectivity of the RPE-SHT complex was positively associated with time and SMH at baseline (p < 0.05). In our study, most eyes showed signs of tissue repair after RPE tear. The reflectivity of repair tissue, the SMH presence and the number of anti-VEGF injections appeared to be major predictors of visual outcomes.

Multimodal Imaging Characteristics and Functional Correlates in Rip Healing

“…This explains the good response of these eyes to prompt and intensive anti-vascular endothelial growth factor treatment following RPE tears reported by several authors. 9,14,22,23 The occurrence of comma-shaped RPE tears was significantly associated with the development of Type 2 or Type 3 healing. Based on this finding, we hypothesize that the shape of the rip may reflect the pathophysiology of the lesion and may have a prognostic value on the possibility of RPE migration to cover the defect.…”

“…This is in line with previous reports; however, the precise identification of newly growing RPE in the presence of an extensive repair tissue can be challenging even for retina specialists. 14 To partially overcome this challenge, we focused our attention on the different characteristics of signal recovery using autofluorescence, and we identified three healing patterns based on the appearance of the repair tissue on BAF and NIRAF (Figure 2).…”

“…10 Different imaging modalities, including optical coherence tomography (OCT) and blue-light autofluorescence, have been used to document the morphological findings typical of rip healing. [10][11][12][13][14] In particular, rips usually appear as areas of markedly reduced autofluorescent signal on BAF because of the significant loss of RPE cells. 3 Blue-light autofluorescence has also been used to document tissue remodeling and RPE repopulation after tears, showing the presence of patchy or hazy hyperfluorescent areas in the previously RPE-denuded zones.…”

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

“…Multimodal imaging features of TARP were consistent with those described elsewhere. 9,11,13,16 Six eyes underwent OCTA; none had detectable vascular flow within TARP on structural OCTA scans (Figure 1).…”

“…9 In some cases, a hyperreflective, optically hypodense repair tissue proliferates between the retina and the denuded Bruch membrane (BM). [10][11][12] Repaired RPE tears have been associated with better visual acuity compared with bare RPE tears, 9,11,13 but the clinical significance of RPE tear-associated repair proliferation (TARP) is uncertain. We hypothesize that the repair of RPE tears may prevent the RPE defect from enlarging over time.…”