Retinal Pigment Epithelium Tears Secondary to Age-Related Macular Degeneration

Abstract

To describe the morphology of retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration by using high-resolution, spectraldomain optical coherence tomography (SD-OCT). Methods: For simultaneous topographic and tomographic in vivo imaging, confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography were applied in combination. Retina over the RPE-denuded area was particularly examined for signs of viable photoreceptors. Results: A total of 26 patients (28 eyes) were included in the study. The mean (SD) age of patients was 78 (8) years (age range, 62-91 years). In cases with recent RPE tears, external limiting membrane, photoreceptor inner and outer segment junction, and nonatrophic outer nuclear layer could be identified in the retina on the RPEdenuded area. Intact external limiting membrane, photoreceptor inner and outer segment junction, and nonatrophic outer nuclear layer could be seen in 1 patient for up to 325 days after the RPE tear. In fibrotic older RPE tears, these structures were atrophic. Conclusions: In this study, signs for viable photoreceptors could be identified for up to 325 days after an RPE tear using spectral-domain optical coherence tomography. This finding is important to consider in future therapies aimed at rescuing photoreceptors after RPE tears.

Associations Between Retinal Pigment Epithelium and Drusen Volume Changes During the Lifecycle of Large Drusenoid Pigment Epithelial Detachments

“…It is important to distinguish disruptions to the RPE+BL band in drusenoid PEDs from RPE rips, which are a recognized complication of neovascular AMD. 31 – 33 Retinal pigment epithelial tears in neovascular AMD are due to abnormal tractional forces acting on the PED and typically occur at the margin, which is the point of greatest mechanical stress in a dome-shaped structure. 32 , 33 Unlike RPE tears due to neovascular AMD, rippling or retraction of the RPE was not seen at sites of RPE+BL disruption in this study.…”

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

“…In our opinion, final inactivity and the status of the retina at the fovea is what really matters. Nevertheless, before starting treatment, it is advisable to verify the condition of the retina through autofluorescence and SD-OCT images to make sure there is a possibility of improvement [40,41]. …”

Recovery of retinal pigment epithelium correlating with restoration of retinal sensitivity in eyes with a retinal pigment epithelial tear

“…We showed that gradual recovery of the RPE accompanied improved retinal sensitivity on MP-1. Some reports showed that the outer retinal structures were preserved in some cases over months after develop-ment of a RPE tear (Bressler et al 1990;Caramoy et al 2011b). These findings suggested that retinal functions that are impaired because of an RPE defect might recover even after a long duration when the RPE layer anatomically recovers in selected cases.…”

“…Some reports showed that the outer retinal structures were preserved in some cases over months after development of a RPE tear (Bressler et al. 1990; Caramoy et al. 2011b).…”

“…However, Caramoy et al. (2011a) reported that the visual acuity improved or remained stable in 3 of 9 eyes after autologous transplant of RPE and choroid in patients with RPE tears.…”