Retinal pigment epithelial tears after single administration of intravitreal bevacizumab for neovascular age-related macular degeneration

Abstract

Purpose To analyse retinal pigment epithelial (RPE) tears following single administration of intravitreal bevacizumab for neovascular agerelated macular degeneration (AMD) during early follow-up. Methods Interventional, retrospective, noncomparative case series included 397 patients (409 eyes) of the 746 consecutive patients that met the eligibility criteria. Standardized visual acuity testing, fluorescein angiography, and optical coherence tomography were performed. Data collected included status of the fellow eye, previous treatment, subtypes of choroidal neovascularization (CNV), size and composition of the lesion. Multiple linear regression modelling was used to explore the effect of baseline parameters on the RPE tears. Primary end point was occurrence of RPE tears within 6 weeks after therapy. Results Fifteen of the 409 eyes (3.6%) developed RPE tear (95% confidence interval: 2.2-6.0, odds ratio: 26.3). The statistical modelling showed significant association between RPE tear and occult without classic CNV/predominantly haemorrhage vs predominantly/minimal classic CNV (P ¼ 0.019), as well as medium or large (44 disc area) vs small size of the total lesion (P ¼ 0.038). Previous treatment and status of the fellow eye did not statistically influence the risk of RPE tears. Conclusions An RPE tear can develop in up to 3.6% of eyes with neovascular AMD following single administration of intravitreal bevacizumab in a short-term follow-up. Medium and large lesion size and occult without classic and predominantly haemorrhagic subtype of CNV were important predictive factors. Preoperative assessment of the lesion characteristics may help in identifying the risk of individual patients with neovascular AMD before intravitreal bevacizumab treatment.

Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments

“…[34][35][36] The first encouraging results in the treatment of serous PED were found with pegaptanib, followed by bevacizumab and ranibizumab. [37][38][39][40] However, these initial reports comprised only small numbers of treated patients. In our larger case series, we found a significant stabilization of VA over a period of 24 weeks after treatment.…”

Can the risk of retinal pigment epithelium tears after bevacizumab treatment be predicted? An optical coherence tomography study

“…6,7,10 Although other factors (eg, CNV and lesion size) should also be considered as potentially contributing factors, the OCT measurement seems to predict the individual risk of patients with neovascular AMD for developing RPE tears. In the case of an increased risk, detailed advice has to be given to the patient and alternative approaches should also be mentioned.…”

“…Clinical characteristics of this cohort of patients are described in detail by a paper recently published. 7 Four of the prospective 397 patients were excluded because of missing or insufficient OCT images.…”

Prospective Evaluation of the Incidence and Risk Factors for the Development of Rpe Tears After High- And Low-Dose Ranibizumab Therapy

“…[4][5][6] The natural history of vascularized PEDs in ARMD is associated with a tear rate of 10% to 12%. [6][7][8][9][10][11][12] In the era of antiangiogenic pharmacotherapies, there has been an explosion of reports of RPE tears after pegaptanib, [13][14][15] bevacizumab, 11,[16][17][18][19][20][21][22][23][24][25][26][27][28] and ranibizumab [29][30][31][32][33][34][35][36][37][38] therapy. 4 Many of these publications have noted a temporal association of tears with intravitreal antivascular endothelial growth factor (VEGF) injection, and 2 groups have determined an RPE tear rate of 17% in eyes with PED that have received anti-VEGF therapy.…”