Pigment epithelial tears after ranibizumab injection in polypoidal choroidal vasculopathy and typical age-related macular degeneration

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Citation: GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, Vol.253(12) : 2151-2160, 2015

MeSH: Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/therapeutic use* ; Choroidal Neovascularization/drug therapy* ; Female ; Fluorescein Angiography ; Humans ; Intravitreal Injections ; Male ; Polyps/drug therapy* ; Postoperative Complications* ; Ranibizumab/therapeutic use* ; Retinal Perforations/diagnosis ; Retinal Perforations/etiology* ; Retinal Pigment Epithelium/injuries ; Retinal Pigment Epithelium/pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Wet Macular Degeneration/drug therapy*

Keywords: Age-related macular degeneration ; Anti-vascular endothelial growth factor ; Polypoidal choroidal vasculopathy ; Ranibizumab ; Retinal pigment epithelial tear

Abstract: PURPOSE: The purpose of the study was to compare the rates and characteristics of retinal pigment epithelial (RPE) tears between typical exudative age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV) after injection of intravitreal ranibizumab (IVR).

METHODS: In total, 836 eyes from 784 patients with exudative AMD treated with IVR were analyzed. The presence, type, size, and height of pigment epithelial detachment (PED) in OCT before injection were evaluated, and the occurrence rate of RPE tears within three months of injection between tAMD and PCV was compared.

RESULTS: In total, 515 eyes (61.6 %) had tAMD and 321 eyes (38.4 %) were diagnosed as PCV. RPE tears developed in 18 eyes (3.5 %) in the tAMD group, while only two eyes (0.62 %) were associated with PCV (p = 0.009, Chi-square test). Eleven of the eighteen eyes with RPE tears in tAMD had fibrovascular PED with contractile neovascular tissue under the surface of the RPE and a cleft at baseline. Two eyes with RPE tears in PCV showed large hemorrhagic PED before presenting with an RPE tear.

CONCLUSIONS: RPE tears after IVR were significantly less common in PCV than in tAMD. The different characteristics of RPE tears between the two disease entities suggest differences in the pathogenesis underlying the event.