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A. Chiang, L. K. Chang, F. Yu, D. Sarraf; Predictors of AntiVEGF-Associated Retinal Pigment Epithelial Tear Using OCT and FA Analysis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5070.
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To identify optical coherence tomography (OCT) and fluorescein angiography (FA) predictors for retinal pigment epithelial (RPE) tear in eyes with pigment epithelium detachment (PED) associated with neovascular age-related macular degeneration (AMD) treated with intravitreal vascular endothelial growth factor (VEGF) modulating therapy.
In an institutional setting, sixty consecutive patients with PED in the setting of neovascular AMD treated with VEGF modulating therapy (either pegaptanib, bevacizumab, or ranibizumab) over a 27-month period were included in the study. FA and OCT imaging was performed prior to and following antiVEGF therapy. Formal statistical analysis comparing the tear group to the non-tear group was performed to identify high-risk features for RPE tear.
RPE tear rate for eyes with vascularized PED receiving antiVEGF therapy was 17% (10/60). There were highly statistically significant differences in the median PED size on FA (greatest linear diameter) (3.2 mm vs. 1.8 mm, respectively; P<0.001) and in the median maximum PED height on OCT (394 um vs. 149 um, respectively; P=0.001) between the tear group and non-tear group. There was also a significant difference in terms of the presence of subretinal fluid on OCT between the two groups (87.5% vs. 39%, respectively; P=0.019).
Large PED basal diameter and vertical height are correlated with an increased risk of developing an RPE tear following antiVEGF therapy. Patients with large vascularized PED by FA and/or OCT analysis should be alerted of the risk for vision loss due to RPE tear following antiVEGF therapy.
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