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A. E. Rosenfeld, J. Shen, G. T. Kokame, J. I. Lim; Retinal Pigment Epithelium Tears Following Intravitreal Injection of Ranibizumab for Treatment of Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3364.
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To report the occurrence and visual outcomes of retinal pigment epithelium (RPE) tears in the eyes of patients with age-related macular degeneration (AMD) and subfoveal choroidal neovascularization (CNV) treated with intravitreal injection of ranibizumab.
Retrospective case review of AMD patients with occult CNV and pigment epithelium detachments (PEDs) who developed RPE tears following treatment with ranibizumab.
Sixty patients underwent ranibizumab injections for subfoveal CNV. Four patients developed RPE tears. Two of the four patients had been treated with other anti-VEGF therapy - pegaptanib sodium (1) and bevacizumab (1) - prior to ranibizumab. Patients were followed monthly. RPE tears were diagnosed 16 days, 63 days, 112 days, and 126 days after beginning ranibizumab therapy. In each case there was fluoroscein angiographic or optical coherence tomographic evidence of retinal pigment epithelium detachments prior to injection of ranibizumab. Baseline visual acuity - i.e., prior to the initial intravitreal injection - was 20/200, 20/40, 20/70, and 20/40, respectively. Visual acuity on the day the RPE rip was noted was 20/100, 20/40, 20/40, and 20/40, respectively. Each patient continued to receive intravitreal injections of ranibizumab as needed after the RPE tear was diagnosed.
To our knowledge this represents the first case series of RPE tears following treatment of subfoveal CNV with ranibizumab. Further studies are needed to determine the true incidence of RPE rips and their potential effect on visual acuity after anti-VEGF therapy for subfoveal CNV.
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