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Joshua Robinson, Caesar Luo, Bruce Garretson; Outcomes of anti-VEGF therapy for exudative macular degeneration with retinal pigment epithelial tears. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3835.
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© ARVO (1962-2015); The Authors (2016-present)
To report outcomes of eyes with exudative macular degeneration undergoing anti-VEGF injections following a retinal pigment epithelial tear (RPET) and to assess the prognostic utility of various OCT findings at diagnosis of RPET.
OCT images of a consecutive series of patients receiving anti-VEGF injections for persistent subretinal fluid associated with RPET were characterized according grade of RPET, absence of subfoveal fibrosis and presence of subfoveal residual RPE. These characteristics were correlated with visual acuity at diagnosis of RPET and at last followup. Statistical significance was set at p<0.05 by Student's t-test.
A retrospective chart review yielded 23 eyes of 23 patients with an average of 15.4 months followup from the time of diagnosis of RPET. Average baseline logMAR visual acuity immediately prior to RPET was 0.691 (SD=0.43). All eyes but one underwent previous intravitreal injection with bevacizumab (N=7), ranibizumab (N=11) or a combination of these drugs (N=3) with an average of 2.2 injections prior to RPET. Average visual acuity decreased to 0.946 (SD=0.63) at diagnosis of RPET, and improved to 0.828 (SD=0.60) at last followup. Visual acuity results by OCT characteristics are shown in Table 1. All subgroups were associated with trending improvement in visual acuity except for eyes with grade 4 RPET. While no subgroup demonstrated a statistically significant change in visual acuity, a significant difference was noted at last followup between Grade 2 (0.419)and Grade 4 eyes (1.209; p=0.034). All 23 eyes presented with subretinal fluid on OCT at diagnosis of RPET, and at last followup 19 (83%) demonstrated improvement in subretinal fluid with complete resolution in 9 (39%) eyes following an average of 9.4 PRN injections of bevacizumab, ranibizumab or aflibercept. No differences were noted in outcomes between anti-VEGF agents.
Long-term visual outcomes in eyes with exudative macular degeneration with RPET are highly variable. Better outcomes are associated with smaller, extrafoveal tears (grade 2). Continued treatment with anti-VEGF agents is associated with improvement or resolution of subretinal fluid in most eyes. Baseline OCT characteristics of RPET grade, subfoveal fibrosis or subfoveal RPE were not predictive of visual improvement with continued anti-VEGF treatment.
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