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M. Quaranta–El, A. El Maftouhi, M. Mauget Faÿsse; Retrospective Analysis of OCT Signs Predicting Retinal Pigment Epithelial Rip in AMD . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2156.
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© ARVO (1962-2015); The Authors (2016-present)
The vascularized detachments of retinal pigment epithelium (DEP) in age–related macular degeneration (AMD) represent a major therapeutic problem due to the risk of rip of the RPE. Trying to obtain prognostic factors able to minimize the risk of iatrogenic RPE rip, we reviewed the OCT scans of DEP patients, before and after a scheduled treatment by IVT with triamcinolone (IVT) plus PDT with Visudyne (PDT).
The OCT data of 54 eyes with a vascularized DEP of AMD have been retrospectively examined before and after an IVT, followed 3 to 4 weeks after (if possible) by a PDT.
The 54 eyes did not present any angiographic sign of pre–rip of the RPE. Seven eyes, 4 weeks after IVT alone, and 4 eyes, 4 to 6 weeks after a combined treatment, showed an RPE rip. In these patients, the analysis of the OCT scans, serially performed on the DEP and the whole macular region, underlined the following abnormalities of the RPE/choriocapillaris (CC) complex:
– Extreme and very focal thinning of the complex giving the appearance of a fragmentation of the RPE (micro–OCT–rip), unrelated to any shadowing effect due to the overlying retinal exudation. This thinning was present as well on the border as on the surface of the elevated complex.
– Focal wrinkling or serrated appearance of the complex with thinning of the RPE.
In all 11 eyes, the RPE rip further appeared where one of these two OCT abnormalities of the complex were visualized.
In the other 43 DEP eyes, that did not progress to a RPE rip during the 6 months following the treatment, the RPE/CC complex was normal or mildly thickened by the neovascular infiltration.
Despite the limits of this retrospective study, our results suggest that the meticulous OCT analysis of the RPE/CC complex in DEP eyes can reduce the risk of iatrogenic RPE rips.
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