Purchase this article with an account.
Connie J. Chen, John T. Thompson, Raymond N. Sjaarda; RPE Tears in Exudative Age-Related Macular Degeneration: A Comparison Between Spontaneous Tears and Tears Associated with anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1775.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare RPE tears in exudative age-related macular degeneration (ARMD) that occured spontaneously and those that occured during treatment with anti-VEGF therapy.
A retrospective review was performed for eyes that developed RPE tears related to exudative ARMD in a single retina practice over 4 years (January 2007- September 2010). Fundus photography, fluorescein angiography, and optical coherence tomography were studied for each tear. Eyes without all three tests were excluded. Using fluorescein angiography the greatest linear diameter was measured in the vector direction of the tear.
Of 25 eyes, 18 were found to have RPE tears during anti-VEGF therapy and 7 were found to have spontaneous RPE tears as the first presentation of exudative ARMD. For tears associated with anti-VEGF therapy, the mean BCVA at the time of tear was 20/250 (20/30-1/200) and the last follow up mean BCVA was 20/400 (20/30-1/200). For spontaneous tears, mean BCVA at the time of tear was 20/250 (20/40-1/200) and last follow up mean BCVA was 20/250 (20/40-1/200). The greatest linear diameter of tears tended to be greater in patients receiving anti-VEGF therapy though this did not achieve statistical significance (mean 2.4 mm vs. 1.7 mm, p=0.094). Seventy-one percent of spontaneous tears were observed to have subretinal hemorrhage compared with 50% of anti-VEGF associated tears, and hemorrhage occupied a larger area of the macula with spontaneous tears. Seventy-one percent of spontaneous tears clearly spared the fovea compared with 33% of anti-VEGF associated tears. All tears in this study were observed to have vector force in the direction of the fovea.
RPE tears can infrequently be the presenting finding in exudative ARMD. Findings in this study suggest that spontaneous tears may present with smaller linear diameter, less frequent foveal involvement and lower incidence of visual acuity loss than those associated with anti-VEGF therapy. Further large-scale studies are needed to better understand the clinical characteristics of these two subsets of patients.
This PDF is available to Subscribers Only