title: A new grading system for retinal pigment epithelial tears.
abstract: OBJECTIVE
  The purpose of this study was to assess the prognostic value of a new grading system for retinal pigment epithelium (RPE) tears that developed after antivascular endo-thelial growth factor (VEGF) therapy for exudative age-related macular degeneration.
  
  
  METHODS
  The authors performed a retrospective review of consecutive eyes that developed an RPE tear after intravitreal injection of an anti-VEGF agent (pegaptanib, bevacizumab, or ranibizumab) within a 4.5-year period (January 2005 to January 2009) at a single center. Fundus photography, fluorescein angiography, and optical coherence topography were studied for each case of RPE tear, and using fluorescein angiography analysis, a measurement of greatest linear diameter (millimeter) was obtained and a grading scale devised. The grade of RPE tear was correlated with visual and anatomical outcomes and response to continued anti-VEGF therapy.
  
  
  RESULTS
  Twenty-one eyes from 20 patients were evaluated in this study. Retinal pigment epithelium tears were graded from one to four based on the greatest length in the vector direction of the tear and involvement of the fovea. Nineteen percent (n = 4) of eyes had Grade 1 tears (diameter smaller than 200 microm), 14% (n = 3) had Grade 2 tears (diameter between 200 microm and 1-disk diameter), 19% (n = 4) had Grade 3 tears (diameter greater than 1-disk diameter), and 48% (n = 10) had Grade 4 tears (Grade 3 tears that involved the foveal center). Lower grade tears were more likely to have better visual acuity and better response to continued anti-VEGF therapy and less likely to develop a disciform scar but were at risk of progressing to a higher grade tear over time.
  
  
  CONCLUSIONS
  The grading of RPE tears according to greatest linear diameter may have prognostic value in predicting visual acuity and anatomical outcome with or without continued anti-VEGF therapy. Lower grade tears have better visual acuity and response to anti-VEGF therapy. Grade 4 tears have a very poor prognosis with or without anti-VEGF therapy.
authors.affiliation: Jules Stein Eye Institute, UCLA Geffen School of Medicine, Los Angeles, California, USA. dsarraf@ucla.edu
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
authors.forename: Shantan
authors.initials: S
authors.lastname: Reddy
authors.forename: Allen
authors.initials: A
authors.lastname: Chiang
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: Atul
authors.initials: A
authors.lastname: Jain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D020256:Choroidal Neovascularization / Q000188:drug therapy; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008268:Macular Degeneration / Q000188:drug therapy; D008297:Male; D011379:Prognosis; D012167:Retinal Perforations / Q000145:classification* / Q000175:diagnosis / Q000209:etiology; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A