title: Retinal pigment epithelium tears after intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration.
abstract: BACKGROUND
  Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab.
  
  
  METHODS
  In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate.
  
  
  RESULTS
  Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%.
  
  
  CONCLUSIONS
  RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.
authors.affiliation: Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Ronan
authors.forename: Pradeepa
authors.initials: P
authors.lastname: Yoganathan
authors.forename: Fred Y
authors.initials: FY
authors.lastname: Chien
authors.forename: Iñigo A
authors.initials: IA
authors.lastname: Corcóstegui
authors.forename: Mark S
authors.initials: MS
authors.lastname: Blumenkranz
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Deramo
authors.forename: Susan G
authors.initials: SG
authors.lastname: Elner
authors.forename: David A
authors.initials: DA
authors.lastname: Fastenberg
authors.forename: Mark W
authors.initials: MW
authors.lastname: Johnson
authors.forename: Mauricio
authors.initials: M
authors.lastname: López
authors.forename: Carlos
authors.initials: C
authors.lastname: Mateo
authors.forename: Darius M
authors.initials: DM
authors.lastname: Moshfeghi
authors.forename: Rafael
authors.initials: R
authors.lastname: Navarro
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Rosenblatt
authors.forename: Steven R
authors.initials: SR
authors.lastname: Sanislo
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Saxe
authors.forename: David N
authors.initials: DN
authors.lastname: Zacks
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