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Alexandra Mouallem, Xuejing Chen, Vittorio Capuano, David Sarraf, Eric H Souied, Giuseppe Querques; Double retinal pigment epithelium tears in neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2832.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the occurrence of double retinal pigment epithelium (RPE) tears in neovascular age-related macular degeneration (AMD) and to elucidate the mechanism of tear development by means of multimodal imaging analysis.
Fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine angiography (ICGA) were studied before and after the occurrence of first and second RPE tear, and at the final visit. Grading system according to the greatest linear diameter was used to classify tears.
Eight eyes of 6 patients (3males; 3 females; mean age 80.8±9.2 years) that developed double RPE tears, either simultaneously (4 eyes) or at variable interval after repeated intravitreal anti-VEGF administration (4 eyes), were included in this study. The mean follow up was 75.7 ± 31.1 months. All eyes received at least 1 anti VEGF injection before the development of the RPE tears, for the treatment of a vascularized pigment epithelium detachment (PED) secondary to AMD. First RPE tears developed after a mean of 4.8±3.2 anti-VEGF injections; second RPE tears developed after a mean of 8.0± 5.2 anti-VEGF injections. Multimodal imaging revealed in all cases a type 1 neovascularization adherent to the posterior surface of the RPE, and crossing the entire PED area with variable orientation; after development of double tear, the RPE appeared retracted on both sides of the neovascular network limits. First tear size at baseline was grade 3 in 6 cases (75%) grade 2 in 1 case (12.5%) and grade 4 in 1 case (12,5%); 1 of the first tears (12.5%) disappeared, while the others maintained the same grading during follow up (45.8±19.1 months; 19.6±11.7 anti-VEGF injections). Second tear size at baseline was grade 4 in 1 case (12.5%), grade 3 in 6 cases (75%) and grade 2 in 1 case (12.5%); all the second tears maintained the same grading during follow up (36.9±24.8 months; 11.7±11.8 anti-VEGF injections).
Double RPE tears may be caused by neovascular contraction on each side of a type 1 neovascularization adherent to the posterior surface of the RPE, and crossing the entire PED area. Tear size stabilizes with repeated anti-VEGF injections.
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