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Christoph R. Clemens, Nina Bastian, Florian Alten, Nicole Eter; Prediction Of Retinal Pigment Epithelial Tears In Serous Vascularized Pigment Epithelium Detachments. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5148.
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Patients with retinal pigment epithelial detachment (PED) secondary to age-related macular degeneration (AMD) with or without choroidal neovascularization (CNV) may suffer from complications such as retinal pigment epithelium (RPE) tears. The aim of our study was to identify predictive characteristics for RPE tears using near-infrared reflectance imaging (IR), spectral-domain optical coherence tomography (SD-OCT) and fluorescence angiography (FLA).
We retrospectively evaluated IR, SD-OCT and FLA findings in 144 eyes of 106 patients diagnosed with PED secondary to AMD. We identified drusenoid PED in 40 eyes (27,8%) and serous avascular PED in 1 eye (0,7%). One hundred three eyes (71.5%) were found to have vascularized PED; out of these, 50 eyes (34.7%) were classified as fibrovascular PED and 53 eyes (36.8%) as serous vascularized PED. Patients with subretinal hemorrhage or additional retinal angiomatous proliferation or chorioretinal anastomosis were excluded.Patients received at least one intravitreal injection of 1.25 mg bevacizumab or 0.5 mg ranibizumab. Treatment was continued until subretinal fluid had disappeared or until complete regression of PED was observed. Follow-up examinations were conducted at intervals of 4-8 weeks.
RPE tears were detected in 15 eyes, representing 10.4% of all eyes analyzed and 14.6% of eyes with vascularized PED. All 15 patients had serous vascularized PED. The mean interval between the last anti-VEGF injection and development of RPE tear was 14.3 (+ 6.9) days. Five patients experienced RPE tears within 3 weeks of the first injection, four patients within 2 weeks after the second injection, two patients within 2 weeks following their third injection, and four patients within a few days after their fourth injection.IR showed hyperreflective strips in a funnel-like array on top of the PED in 11 of these patients prior to the occurrence of the rip, apparently emanating from CNV. On SD-OCT these strips correlated with small folds in the RPE. In all cases the rip was located opposite to the CNV, at the margin of the RPE detachment.
Hyperreflective strips evident on IR prior to RPE tears in PED correspond to structural changes of the RPE following anti-VEGF therapy. This observation supports the hypothesis that anti-VEGF treatment may lead to contraction of vascular tissue beneath the PED. This may result in tangential shear across the PED and subsequent RPE tear on the opposite side of CNV. These changes observed on IR and SD-OCT may represent indicators for a forthcoming RPE tear. Additional studies are needed to confirm these observations.
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