title: Retinal pigment epithelial tears after intravitreal bevacizumab injection for neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To study retinal pigment epithelium (RPE) tears after off-label intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) injection for neovascular age-related macular degeneration. Eyes with a vascularized pigment epithelial detachment (PED) that developed an RPE tear were compared with eyes with a vascularized PED but without an RPE tear.
  
  
  METHODS
  Nine retina specialists across the United States and in Europe participated in this retrospective case series. All eyes that received intravitreal bevacizumab injection for choroidal neovascularization (CNV) over 12 months (October 2005 to September 2006) were included. Eyes without all three confirmed tests (fluorescein angiography, fundus photography, and optical coherence tomography) were excluded from analysis. Statistical analyses were performed on multiple characteristics of eyes with a vascularized PED that did and did not develop an RPE tear.
  
  
  RESULTS
  Among 2,785 intravitreal bevacizumab injections for 1,064 eyes, RPE tears were found in 22 eyes in 22 patients (2.2%). A vascularized PED was present in 21 of 22 eyes that developed an RPE tear (17.1% of PED eyes; 15, 100% occult CNV; 6, predominantly occult CNV). Mean interval from bevacizumab injections to RPE tears was 37.3 days. Mean follow-up time was 124.9 days. Mean subfoveal PED size was larger for eyes with tears than for those without tears (13.97 mm vs 9.9 mm, respectively; P = 0.01; odds ratio, 1.09). There was substantially smaller mean ratio of CNV size to PED size for eyes with tears than for those without tears (27.9% vs 67.6%, respectively; P = 0.005). Mean pre-bevacizumab injection best-corrected Snellen visual acuity was 20/162, and mean post-RPE tear best-corrected visual acuity was 20/160 (P = 0.48).
  
  
  CONCLUSIONS
  Large PED size is a predictor for RPE tears, and a small ratio of CNV size to PED size (<50%) is more common in eyes with RPE tears. Vision may be preserved despite RPE tears.
authors.affiliation: Southern California Desert Retina Consultants, Palm Springs, CA 92263, USA. Pschan@aol.com
authors.forename: Clement K
authors.initials: CK
authors.lastname: Chan
authors.forename: Carsten H
authors.initials: CH
authors.lastname: Meyer
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gross
authors.forename: Prema
authors.initials: P
authors.lastname: Abraham
authors.forename: Asha S D
authors.initials: AS
authors.lastname: Nuthi
authors.forename: Gregg T
authors.initials: GT
authors.lastname: Kokame
authors.forename: Steven G
authors.initials: SG
authors.lastname: Lin
authors.forename: Michael E
authors.initials: ME
authors.lastname: Rauser
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D010857:Pigment Epithelium of Eye / Q000187:drug effects* / Q000473:pathology; D012163:Retinal Detachment / Q000139:chemically induced / Q000175:diagnosis; D012167:Retinal Perforations / Q000139:chemically induced* / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab