title: Prospective evaluation of the incidence and risk factors for the development of RPE tears after high- and low-dose ranibizumab therapy.
abstract: OBJECTIVE
  To prospectively determine the incidence and risk factors for retinal pigment epithelial (RPE) tears in eyes with vascularized pigment epithelial detachments (PED) and exudative age-related macular degeneration receiving antivascular endothelial growth factor therapy.
  
  
  METHODS
  Eyes were prospectively randomized into 1 of 4 arms: 1) 0.5 mg of ranibizumab monthly for 12 months; 2) 0.5 mg of ranibizumab monthly for 3 months and then pro re nata on the basis of clinical and optical coherence tomography-guided indications; 3) high-dose 2.0 mg of ranibizumab monthly for 12 months; or 4) 2.0 mg of ranibizumab monthly for 3 months and then pro re nata thereafter. All PEDs were measured for height, greatest linear diameter, and surface area at baseline. The incidence of RPE tears in the entire 4-arm cohort was determined at the end of 12 months. Eyes were divided into two groups (tear vs. nontear) and statistically compared to determine risk factors for the development of RPE tear.
  
  
  RESULTS
  Of 37 eyes, a total of 5 developed postranibizumab RPE tears during the course of the study (incidence 14%). Four of the 5 tears occurred in the high-dose 2.0-mg groups. Baseline PED height, surface area, and greatest linear diameter were significantly greater in the group that developed RPE tears versus the nontear group (P = 0.018, 0.031, and 0.048, respectively). There were significantly more eyes with PED height >550 microns in the RPE tear group (4 of 5, 80%) compared with the nontear group (9 of 32, 18%) (P = 0.042). The presence of PED height >550 microns was associated with an increased tear rate from 14% to 31%. Furthermore, retrospective identification of a ring sign or Grade 1 tear at baseline, in addition to PED height >550 microns, was associated with a further increase in the tear rate to 67%.
  
  
  CONCLUSIONS
  In this study, the prospective incidence of RPE tears was ∼14%. A baseline PED height >550 microns and presence of a Grade 1 tear, or positive ring sign, were identified as high-risk factors for the subsequent development of an RPE tear.
authors: Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA.
authors: David
authors: D
authors: Sarraf
authors: Clement
authors: C
authors: Chan
authors: Ehsan
authors: E
authors: Rahimy
authors: Prema
authors: P
authors: Abraham
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D000069579:Ranibizumab; D012167:Retinal Perforations / Q000175:diagnosis / Q000453:epidemiology*; D055213:Retinal Pigment Epithelium / Q000098:blood supply / Q000473:pathology*; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab