title: Pigment epithelial tears associated with anti-VEGF therapy: incidence, long-term visual outcome, and relationship with pigment epithelial detachment in age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate the prevalence of retinal pigment epithelium (RPE) tears associated with anti-VEGF therapy and its relation with retinal pigment epithelial detachment (PED).
  
  
  METHODS
  A total of 226 patients with exudative age-related macular degeneration treated with intravitreal anti-VEGF were included retrospectively in the study. The presence of RPE tears; the effect of the presence, height, and duration of PED on the rate of RPE tears; and change in visual acuity during follow-up were recorded.
  
  
  RESULTS
  Among 226 study patients, 28 (12.3%) had RPE tears. The RPE tear rate was significantly higher in patients with vascularized PED (vPED) than in those without PED (19.7% vs. 2.1%; P < 0.001). The change in visual acuity after the formation of RPE tear was not statistically significant (on logMAR scale: 0.92 ± 0.49 initially, 0.89 ± 0.41 after the RPE tear, 0.96 ± 0.45 at the last follow-up; P = 0.613). Pigment epithelial detachment height >580 μm (odds ratio = 69.4; 95% confidence interval = 16.7-288.1) and PED duration ≤ 4.5 months (odds ratio = 166.7; 95% confidence interval = 15.2-1000) were found to be significant risk factors for RPE tear formation.
  
  
  CONCLUSIONS
  The RPE tears are not infrequent among eyes treated with intravitreal anti-VEGFs. The presence, increased height, and shorter duration of vPED are potential risk factors for RPE tears associated with anti-VEGF therapy.
authors.affiliation: Department of Ophthalmology, Gazi University, Besevler, Ankara, Turkey. Sibel Doguizi is now with Department of Ophthalmology, Dogubeyazit State Hospital, Agri, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Doguizi
authors.forename: Sengul
authors.initials: S
authors.lastname: Ozdek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000068258:Bevacizumab; D005260:Female; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D000069579:Ranibizumab; D012163:Retinal Detachment / Q000188:drug therapy*; D012167:Retinal Perforations / Q000139:chemically induced* / Q000453:epidemiology; D055213:Retinal Pigment Epithelium; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab