title: Spontaneous or secondary to intravitreal injections of anti-angiogenic agents retinal pigment epithelial tears in age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate the visual function evolution of retinal pigment epithelial (RPE) tears in patients with age-related macular degeneration (AMD) according to type of occurrence [spontaneous or secondary to anti-vascular endothelial growth factor (anti-VEGF) injection] and the topographic location of the tear after a two-year follow-up period.
  
  
  METHODS
  A total of 15 eyes of 14 patients with RPE tears in exudative AMD were analyzed retrospectively at the University Eye Clinic of Trieste. Inclusion criteria were: patient age of 50 or older with AMD and RPE tears both spontaneous occurring or post anti-VEGF treatment. Screening included: careful medical history, complete ophthalmological examination, fluorescein angiography (FA), indocyanine green angiography (ICG), autofluorescence and infrared imaging and optical coherence tomography (OCT). Patients were evaluated every month for visual acuity (VA), fundus examination and OCT. Other data reported were: presence of PED, number of injections before the tear, location of the lesion.
  
  
  RESULTS
  Mean follow-up was 24wk (SD±4wk). A total of 15 eyes were studied for RPE tear. In 6 cases (40%), the RPE tears occurred within two years of anti-VEGF injections the others occurred spontaneously. In 13 cases (86.6%), the RPE tear was associated with pigment epithelial detachment (PED). In 7 cases (46.6%), the RPE tear occurred in the central area of the retina and involved the fovea. Two lesions were found in the parafoveal region, six in the extra-macular area. In all cases visual acuity decreased at the end of the follow-up period (P<0.01) independently of the type or the topographical location of the lesion.
  
  
  CONCLUSIONS
  RPE tear occurs in exudative AMD as a spontaneous complication or in relation to anti-VEGF injections. Visual acuity decreased significantly and gradually in the follow-up period in all cases. No correlation was found between visual loss and the type of onset or the topographic location of the tears.
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Pia E
authors.initials: PE
authors.lastname: Leon
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Saviano
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanei
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Pastore
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Guaglione
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mangogna
authors.affiliation: University Eye Clinic of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 1, Trieste 34125, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Tognetto
keywords: age-related macular degeneration; anti-vascular endothelial growth factor treatment; retinal pigment epithelial; tears; visual acuity