Change in vision after retinal pigment epithelium tear following the use of anti-VEGF therapy for age-related macular degeneration.
OBJECTIVE
We investigated visual acuity outcomes and their associations in the setting of retinal pigment epithelium tear (RPET) following the use of anti-vascular endothelial growth factor (anti-VEGF) agents.


METHODS
This retrospective review included all patients treated for neovascular age-related macular degeneration (AMD) with an anti-VEGF agent who subsequently developed an RPET. All patients who developed an RPET were identified and outcome measures data were recorded and analysed. The main outcome measures were best corrected visual acuity (BCVA) and spectral domain optical coherence tomography characteristics.


RESULTS
Among the 14 participants identified, a subfoveal RPET was associated with the loss of one or more lines of vision from baseline (p = 0.03). There was no association between the size of the RPET and BCVA at the time of the RPET or final BCVA. The development of a disciform scar was associated both with a BCVA at the time of the RPET of < 6/24 (p = 0.02) and a final BCVA of < 6/24 (p = 0.02). Ongoing treatment with an anti-VEGF agent following an RPET saw five patients (35.7 %) have an improvement in their BCVA and all patients maintained their BCVA following the RPET with ongoing anti-VEGF treatment.


CONCLUSIONS
Visual decline following an RPET is associated with subfoveal location of the RPET (p = 0.03) and later development of a disciform scar. These data also suggest that the ongoing use of an anti-VEGF agent may stabilise vision in some patients following an RPET and for some patients there may be an improvement in visual acuity despite the RPET, depending on its location.
Discipline of Ophthalmology and Visual Science, The University of Adelaide, Level 8, East Wing, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.|Adelaide Eye and Retina Centre, 18 North Terrace, Adelaide, South Australia, Australia.
Shane R
SR
Durkin
Discipline of Ophthalmology and Visual Science, The University of Adelaide, Level 8, East Wing, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. lachlan.farmer@gmail.com.
Lachlan D M
LD
Farmer
Vitreoretina Fellow, Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Susith
S
Kulasekara
Discipline of Ophthalmology and Visual Science, The University of Adelaide, Level 8, East Wing, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.|Adelaide Eye and Retina Centre, 18 North Terrace, Adelaide, South Australia, Australia.
Jagjit
J
Gilhotra
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000068258:Bevacizumab / Q000009:adverse effects; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000009:adverse effects; D012167:Retinal Perforations / Q000209:etiology / Q000503:physiopathology*; D055213:Retinal Pigment Epithelium / Q000293:injuries*; D012189:Retrospective Studies; 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
D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab
Bevacizumab; Ranibizumab; Retinal pigment epithelium; Rip; Tear; Visual acuity