Retinal Pigment Epithelium Tear

Abstract

Retinal pigment epithelium (RPE) tear is a potentially vision-threatening complication of retinal pigment epithelial detachment associated with neovascular age-related macular degeneration. RPE tear has been reported to occur spontaneously and after treatment with anti-vascular endothelial growth factor agents. The current study summarizes the presentation, diagnosis, management, and outcomes of RPE tears.

OCT Biomarkers in Neovascular Age-Related Macular Degeneration: A Narrative Review

“…Small RPE ruptures appear as a tented up or peaked PED with a microscopic RPE defect. As the grade of the RPE rip increases, OCT shows a wider patch of RPE loss with the redundant RPE taking on a dome-shaped configuration [78]. e retracted RPE is observed with an irregular contour, dense hyperreflectivity from duplication of the RPE, and a shadowing effect beneath it [68,77].…”

“…ese processes together create a weak point at the junction of the detached and flat RPE, where the tear occurs. e tear is followed by retraction of the pigment epithelium, revealing bare Bruch's membrane [78]. Several authors propose that intravitreal anti-VEGF treatment could increase the risk of early tearing, possibly by shrinking the neovascular complex, thereby creating an extra contraction force in a PED at risk and triggering the tear of the RPE [2].…”

“…Several authors propose that intravitreal anti-VEGF treatment could increase the risk of early tearing, possibly by shrinking the neovascular complex, thereby creating an extra contraction force in a PED at risk and triggering the tear of the RPE [2]. Despite multiple reports, not all studies support these conclusions [78]. ere is still no evidence that any anti-VEGF agent is safer than the others [78].…”

“…Despite multiple reports, not all studies support these conclusions [78]. ere is still no evidence that any anti-VEGF agent is safer than the others [78]. In eyes with high-risk, alternative anti-VEGF treatment protocols such as low-dose and frequent injection treatments have been proposed.…”

“…In eyes with high-risk, alternative anti-VEGF treatment protocols such as low-dose and frequent injection treatments have been proposed. However, there is no proven method to foresee the development of RPE tears [78].…”