Retinal Pigment Epithelial Tears After Intravitreal Bevacizumab Injection for Neovascular Age-Related Macular Degeneration

Chan, Clement K.; Meyer, Carsten H.; Gross, Jeffrey G.; Abraham, Prema; Nuthi, Asha S. D.; Kokame, Gregg T.; Lin, Steven G.; Rauser, Michael; Kaiser, Peter K.

doi:10.1097/iae.0b013e3180cc2612

Cited by 157 publications

(149 citation statements)

References 42 publications

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“…The result of our and previous studies is in accordance with the high risk for the occult CNV subtype. Similar to the study of Chan et al 24 we did not observe a significant association between the occurrence of RPE tears and the status of the fellow eye and previous treatment within a short follow-up period. As reported in other studies, the vision in eyes with RPE tear did not show an acute decrease.…”

Section: Eyesupporting

confidence: 90%

“…[29][30][31][32][33][34] Case series recently highlighted RPE tear increase after intravitreal bevacizumab treatment of neovascular AMD. [14][15][16][17][18][19][20][21][22][23][24][25][26] Chan et al 24 reported in a multicenter collective study 2.2% RPE tears in 1064 eyes. In a subgroup of 123 eyes with PED, 21 eyes (17.1%) had an RPE tear after intravitreal bevacizumab therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] In contrast, some cases of retinal pigment epithelial (RPE) tears after bevacizumab therapy have recently been reported. [15][16][17][18][19][20][21][22][23][24][25][26] Since intravitreal bevacizumab is a widely used therapy option for neovascular AMD, there is a need for further information on this topic. We analysed the occurrence of the RPE tear and the influence of related factors on this entity in a short-tem follow-up period following a single intravitreal bevacizumab administration for neovascular AMD.…”

Section: Introductionmentioning

confidence: 99%

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

Gelişken¹,

Ziemssen²,

Voelker³

et al. 2008

Eye

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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.

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Section: Eyesupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gelişken¹,

Ziemssen²,

Voelker³

et al. 2008

Eye

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“…3 Such vascularized PEDs (vPED) have poor therapeutic response. 1,3,5,6 Pilot studies showed variable responses of vPED to anti-VEGF therapy. 1,7,8 The ANCHOR and MARINA studies demonstrated improved vision in eyes receiving monthly ranibizumab injections (RI).…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies showed retinal pigment epithelial detachment (PED) developing in more than 80% of eyes with exudative age-related macular degeneration (AMD); [1][2][3][4] with B70% of the PED cases demonstrating vascularization. 3 Such vascularized PEDs (vPED) have poor therapeutic response.…”

Section: Introductionmentioning

confidence: 99%

Earlier therapeutic effects associated with high dose (2.0 mg) Ranibizumab for treatment of vascularized pigment epithelial detachments in age-related macular degeneration

Chan

Abraham

Sarraf

et al. 2014

Eye

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Summary statement Intravitreal high dose (2 mg) ranibizumab may lead to quicker resolution of choroidal neovascularization (CNV) and associated retinal pigment epithelial detachment in eyes with exudative age-related macular degeneration, although it may possibly correlate with RPE tears in certain cases. Purpose This prospective study compared the outcomes of 0.5 vs 2.0 mg intravitreal ranibizumab injections (RI) for treating vascularized pigment epithelial detachment (vPED) due to age-related macular degeneration. Methods Patients with vPED were randomized to receive 2.0 vs 0.5 mg RI monthly for 12 months or for 4 months and then repeated on a pro-re nata basis. Optical coherence tomography, fundus photography, and fluorescein and indocyanine-green angiography were obtained at baseline and subsequent specific intervals. Outcome measures were best-corrected standardized visual acuities, central 1-mm thickness, surface area (SA), greatest linear diameter (GLD), heights (PED and CNV), and amount of subretinal fluid (SRF) and cystoid macular edema (CME). Results Both groups yielded reductions of the central 1-mm thickness, PED and CNV SA and PED height and GLD, SRF, and CME. Vision improvement and reduction in SRF and PED height occurred earlier for eyes receiving the 2.0 mg dose. Cataract progression was similar but RPE tears developed more often with the 2.0 mg dose. Conclusions There were similar visual and anatomical outcomes at the end of the study; however, the higher dose yielded more rapid reductions and more complete resolution of the PED, although there was possible increased tendency for an RPE tear with the higher dose.

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Retinal Pigment Epithelium Tears Secondary to Age-Related Macular Degeneration

Caramoy

Kirchhof²,

Fauser³

2011

Arch Ophthalmol

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To describe the morphology of retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration by using high-resolution, spectraldomain optical coherence tomography (SD-OCT). Methods: For simultaneous topographic and tomographic in vivo imaging, confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography were applied in combination. Retina over the RPE-denuded area was particularly examined for signs of viable photoreceptors. Results: A total of 26 patients (28 eyes) were included in the study. The mean (SD) age of patients was 78 (8) years (age range, 62-91 years). In cases with recent RPE tears, external limiting membrane, photoreceptor inner and outer segment junction, and nonatrophic outer nuclear layer could be identified in the retina on the RPEdenuded area. Intact external limiting membrane, photoreceptor inner and outer segment junction, and nonatrophic outer nuclear layer could be seen in 1 patient for up to 325 days after the RPE tear. In fibrotic older RPE tears, these structures were atrophic. Conclusions: In this study, signs for viable photoreceptors could be identified for up to 325 days after an RPE tear using spectral-domain optical coherence tomography. This finding is important to consider in future therapies aimed at rescuing photoreceptors after RPE tears.

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Retinal Pigment Epithelial Tears After Intravitreal Bevacizumab Injection for Neovascular Age-Related Macular Degeneration

Abstract: Large PED size is a predictor for RPE tears, and a small ratio of CNV size to PED size (<50%) is more common in eyes with RPE tears. Vision may be preserved despite RPE tears.

Cited by 157 publications

References 42 publications

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

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

Earlier therapeutic effects associated with high dose (2.0 mg) Ranibizumab for treatment of vascularized pigment epithelial detachments in age-related macular degeneration

Retinal Pigment Epithelium Tears Secondary to Age-Related Macular Degeneration

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