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S. M. Ronan, S. G. Elner, M. W. Johnson, S. J. Saxe, D. N. Zacks; Retinal Pigment Epithelium Tears After Intravitreal lnjection of Bevacizumab (Avastin) for Exudative Age-Related Macular Degeneration in Patients With Serous Pigment Epithelial Detachments. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3376.
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Intravitreal bevacizumab (Avastin, Genentech, Inc., San Fransisco, CA) treatment of exudative age-related macular degeneration (AMD) has become an important part of clinical retinal practice. To date, there have been few detailed reports of serious ocular complications of intravitreal injection of bevacizumab. The report a potentially devastating complication of the intravitreal injection of bevacizumab in patients with neovascular AMD.
In this retrospective case series, we report four cases of retinal pigment epithelium tears (RPE) after intravitreal bevacizumab injection in neovascular age-related macular degeneration. The total number of intravitreal injections of bevacizumab were compiled in order to estimate the incidence of this complication.
In each case, the RPE tear was preceded by an RPE detachment with a serous component. Addition, all tears occurred within the first week to the sixth week following the injection. From October 2005 to June 2006 the University of Michigan Retinal Service performed a total of 345 intravitreal bevacizumab injections in 174 patients with four RPE tears but no other significant ocular complications noted. This suggests that the incidence of this complication may exceed 1%.
Although RPE tears are known to occur spontaneously in patients with CNV in AMD, the close temporal association between the drug injection and the onset of the RPE tear in these patients suggests an association. RPE tears may develop after intravitreal bevacizumab injection in patients found to have pre-existing pigment epithelial detachment with a serous component. Regardless of whether the injection of bevacizumab leads to or simply hasten the development of RPE tears, caution should be exercised when treating neovascular AMD with a serous component. In addition, the risk of RPE tears should be discussed with patients considering this intervention.
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