title: Repair mechanism of retinal pigment epithelial tears in age-related macular degeneration.
abstract: OBJECTIVE
  To investigate repair mechanisms of retinal pigment epithelial (RPE) tears in age-related macular degeneration.
  
  
  METHODS
  The authors retrospectively studied 10 eyes with age-related macular degeneration that developed RPE tears during follow-up or after treatment with an anti-vascular endothelial growth factor drug or photodynamic therapy combined with ranibizumab. After development of the RPE tears, all follow-ups exceeded 13 months. Spectral domain or swept-source optical coherence tomography have been used to examine consecutive retinal changes where the RPE tears developed and attempted to determine the repair mechanisms.
  
  
  RESULTS
  Retinal pigment epithelial tears developed during the natural course (n = 4) after ranibizumab treatment (n = 2) and after photodynamic therapy and ranibizumab (n = 4). Subretinal fluid persisted for more than 6 months after the RPE tears developed (n = 4), with the area where the RPE was lost found to be covered with thickened proliferative tissue. In 6 eyes where the subretinal fluid was absorbed within 2 months, optical coherence tomography showed the outer retina appeared to be directly attached to Bruch membrane, and there was attenuation of the normal hyperreflective band attributable to normal RPE during follow-up.
  
  
  CONCLUSIONS
  Results suggest that two repair processes may be present in the area where RPE tears developed. Persistent subretinal fluid may lead to repair with thick proliferative tissue, while the outer retina appears to attach to Bruch membrane when there is early subretinal fluid resolution after RPE tear development.
authors.affiliation: Department of Ophthalmology, School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Mukai
authors.forename: Taku
authors.initials: T
authors.lastname: Sato
authors.forename: Shoji
authors.initials: S
authors.lastname: Kishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D010778:Photochemotherapy; D000069579:Ranibizumab; D012167:Retinal Perforations / Q000175:diagnosis / Q000503:physiopathology*; D055213:Retinal Pigment Epithelium / Q000503:physiopathology*; D012189:Retrospective Studies; D058471:Subretinal Fluid / Q000502:physiology; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab