title: Predictors of anti-VEGF-associated retinal pigment epithelial tear using FA and OCT analysis.
abstract: OBJECTIVE
  To identify fluorescein angiography and optical coherence tomography (OCT) predictors for retinal pigment epithelial (RPE) tear in eyes with pigment epithelium detachment (PED) associated with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor (VEGF) modulating therapy.
  
  
  METHODS
  Retrospective comparative case series.
  
  
  METHODS
  In a single institutional center, 60 consecutive patients with PED and neovascular age-related macular degeneration treated with VEGF modulating therapy (either pegaptanib, bevacizumab, or ranibizumab) for more than a 27-month period were included in the study. Fluorescein angiography (FA) and OCT imaging was performed before and after anti-VEGF therapy. Formal statistical analysis comparing the tear group to the nontear group was performed to identify high-risk features for RPE tear.
  
  
  RESULTS
  RPE tear rate for eyes with vascularized PED receiving anti-VEGF therapy was 17% (10/60). There were highly statistically significant differences in the median PED size on fluorescein angiography (greatest linear diameter) (3.2 mm versus 1.8 mm, respectively; P < 0.001) and in the median maximum PED height on OCT (394 mum versus 149 mum, respectively; P = 0.001) between the tear group and nontear group. There was also a significant difference in terms of the presence of subretinal fluid on OCT between the two groups (87.5% versus 39%, respectively; P = 0.019).
  
  
  CONCLUSIONS
  Large PED basal diameter and vertical height are correlated with an increased risk of developing an RPE tear after anti-VEGF therapy. Patients with large vascularized PED by fluorescein angiography and/or OCT analysis should be alerted of the risk for vision loss due to RPE tear after anti-VEGF therapy.
authors.affiliation: Jules Stein Eye Institute, University of California-Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Chiang
authors.forename: Louis K
authors.initials: LK
authors.lastname: Chang
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000009:adverse effects / Q000627:therapeutic use; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008268:Macular Degeneration / Q000150:complications; D008297:Male; D011237:Predictive Value of Tests; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000175:diagnosis* / Q000209:etiology; D012167:Retinal Perforations / Q000139:chemically induced*; D055213:Retinal Pigment Epithelium / Q000098:blood supply; D012171:Retinal Vessels / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab