title: Long-term visual outcome of pigment epithelial tears in association with anti-VEGF therapy of pigment epithelial detachment in AMD.
abstract: OBJECTIVE
  Retinal pigment epithelium (RPE) tears may develop as a complication after anti-VEGF (vascular endothelial growth factor) treatment for pigment epithelial detachments (PEDs) in exudative age-related macular degeneration (AMD). This retrospective study analyses best-corrected visual acuity (BCVA) and foveal involvement after RPE tears that are associated with anti-VEGF therapy due to PED in exudative AMD.
  
  
  METHODS
  A total of 37 patients with RPE tears during anti-VEGF therapy (bevacizumab 12, ranibizumab 21 and pegaptanib 4 eyes) for progressive PED in AMD (PED with occult choroidal neovascularization 25 eyes and PED with retinal angiomatous proliferation 12 eyes) were included in this study. We analyzed BCVA and different morphologic aspects by means of appearance on fluorescein angiography and optical coherence tomography. Mean follow-up was 88 weeks.
  
  
  RESULTS
  RPE tears were diagnosed a mean of 56 days after the first injection. BCVA deteriorated after RPE tear and during follow-up significantly (P<0.001), with 53.2% of eyes being legally blind (WHO, world health organization) at 12 months. RPE-free foveal area, foveal wrinkling of the RPE, and fibrotic scar development were significantly associated with worse visual acuity.
  
  
  CONCLUSIONS
  RPE tears can be observed in 12-15% of treated eyes during anti-VEGF therapy for PED in exudative AMD. Owing to the close time relationship with the therapy, this complication must be taken into consideration. Visual prognosis is associated with a decrease in vision in the long term, often resulting in a severe visual disability. Relevant factors for a negative visual prognosis were the potential foveal involvement of the central RPE and morphologic fibrovascular transformation of the RPE tear.
authors.affiliation: Department of Ophthalmology, St Franziskus Hospital, Muenster, Germany. matthiasgutfleisch@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Gutfleisch
authors.forename: B
authors.initials: B
authors.lastname: Heimes
authors.forename: M
authors.initials: M
authors.lastname: Schumacher
authors.forename: M
authors.initials: M
authors.lastname: Dietzel
authors.forename: A
authors.initials: A
authors.lastname: Lommatzsch
authors.forename: A
authors.initials: A
authors.lastname: Bird
authors.forename: D
authors.initials: D
authors.lastname: Pauleikhoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000009:adverse effects; D000068258:Bevacizumab; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000188:drug therapy*; D012167:Retinal Perforations / Q000139:chemically induced* / Q000503:physiopathology; D041623:Tomography, Optical Coherence; D042442:Vascular Endothelial Growth Factors / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042442:Vascular Endothelial Growth Factors; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab