title: DOUBLE RETINAL PIGMENT EPITHELIUM TEARS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
abstract: OBJECTIVE
  To describe the occurrence and treatment outcomes of double retinal pigment epithelium (RPE) tears in neovascular age-related macular degeneration and to elucidate the mechanism of tear development by means of multimodal imaging analysis.
  
  
  METHODS
  Fundus autofluorescence, spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography were retrospectively studied before and after the occurrence of first and second RPE tears and at the final visit.
  
  
  RESULTS
  Twelve eyes of 10 patients that developed double RPE tears, either simultaneously (6 eyes) or at variable intervals after repeated intravitreal anti-vascular endothelial growth factor administration (6 eyes), were included. First RPE tears developed after a mean of 4.5 ± 2.7 anti-vascular endothelial growth factor injections; second RPE tears developed after a mean of 7.1 ± 5.2 anti-vascular endothelial growth factor injections. Mean best-corrected visual acuity was 20/63 at baseline evaluation, 20/76 after occurrence of first tear, 20/90 after occurrence of second tear, and 20/95 at final visit (P > 0.05 for all). Multimodal imaging revealed in all cases a Type 1 neovascular lesion adherent to the posterior surface of the RPE and spanning a significant portion of the pigment epithelium detachment with variable orientation; after development of double tears, the RPE seemed retracted on both borders of the neovascular network.
  
  
  CONCLUSIONS
  Double RPE tears may occur on opposite sides of a vascularized pigment epithelium detachment, in eyes with neovascular age-related macular degeneration after anti-vascular endothelial growth factor therapy, because of neovascular contraction of a Type 1 neovascular complex, adherent to the posterior surface of the RPE and spanning a significant portion of the pigment epithelium detachment area.
authors.affiliation: *Department of Ophthalmology, Centre Hospitalier Intercommunal de Creteil, University Paris Est Creteil, Creteil, France; †Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; ‡Greater Los Angeles VA Healthcare System, Los Angeles, California; and §Kaiser Permanente Medical Center, Woodland Hills, California.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mouallem
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
authors.forename: Xuejing
authors.initials: X
authors.lastname: Chen
authors.forename: Vittorio
authors.initials: V
authors.lastname: Capuano
authors.forename: Eric H
authors.initials: EH
authors.lastname: Souied
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D064847:Multimodal Imaging; D061848:Optical Imaging; D012167:Retinal Perforations / Q000175:diagnosis* / Q000209:etiology*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; 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 / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A