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Hisashi Matsubara, Koichi Matsunaga, Ryohei Miyata, Yoshitsugu Matsui, Mineo Kondo; Preoperative Predictive Factor of Retinal Pigment Epithelium Tear after treatment of eyes with Age-Related Macular Degeneration Associated with Large Vascularized Retinal Pigment Epithelium Detachment. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3843.
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It is known that retinal pigment epithelium (RPE) tears can develop several weeks after the treatment of eyes with age-related macular degeneration (AMD) especially in eyes are with an RPE detachment (PED). However, it is not known what types of PED have a higher risk for RPE tears after the treatment. The purpose of this study was to determine whether a lower size ratio of choroidal neovascularization (CNV) to PED can be a high risk factor for RPE tears.
We reviewed the medical records of 433 eyes of 414 patients with AMD treated with photodynamic therapy (PDT) or an intravitreal injection of ranibizumab (IVR) or aflibercept (IVA). The eyes with large and highly serous vascularized PEDs (diameter >1 disc diameter and height >400 µm) and were followed at least 3 months were studied. Optical coherence tomography (OCT) and fluorescein and indocyanine angiography (FA/ IA) were used to determine the CNV margin that contacted the PED. We measured the linear length of this margin (a) and the distance from this margin to the opposite edge of the serous PED (b). We compared the height and longer axis of the PED and the b/a ratio between eyes with a RPE tear (+) or without a RPE tear (-) .
We found that 21 eyes of 21 patients had large and highly serous vascularized PEDs before the treatment. RPE tears occurred in 7 of these 21 eyes at 23.3±18.2 days after the treatment. There was no significant difference in age, sex, PED size, and PED height between the two groups. However, the b/a ratio was significantly lower in RPE tear (+) group (0.59 ± 0.42) than RPE tear (-) group (1.53 ± 0.92, P<0.011; unpaired t test).
The higher risk of eyes with lower b/a ratio for developing a postoperative RPE tear suggests that RPE tears are caused by a local traction by a contraction of the CNV postoperatively.
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