Abstract
Purpose: :
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.
Methods: :
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.
Results: :
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).
Conclusions: :
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.
Keywords: retinal pigment epithelium • age-related macular degeneration • vascular endothelial growth factor