Tears of The Retinal Pigment Epithelium – A Review

Abstract

Tears of the retinal pigment epithelium (RPE)

Healing pattern of subfoveal retinal pigment epithelium rip and aperture in central serous chorioretinopathy

“…Typical RPE rips, usually developing along the edge of the PED, appear as well-demarcated crescentic areas of the bare choroid with retracted and rolled torn edge of the RPE orienting itself parallel to the margin of the tear. [ 1 5 ] Spontaneous rip develops in AMD following a sudden increase in the vascular permeability of the neovascular membrane resulting in sudden enlargement of PED leading to the rippling of the RPE, whereas sudden contraction of underlying vascular membrane following anti-VEGF therapy or PDT is implicated in the development of rip following treatment. [ 1 5 6 ] Unlike AMD, the incidence of RPE tears in CSC is considerably lower owing to the absence of the contraction forces from the neovascular membrane and is usually atypical.…”

“…The incidence of retinal pigment epithelium (RPE) tears in central serous chorioretinopathy (CSC)-associated serous pigment epithelial detachments (PEDs) is rare compared to those complicating vascularized PEDs secondary to neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy. [ 1 2 3 ] The RPE rip is a classical form of large RPE tear, associated with 10%–17% of AMD-related vascularized PED, developing either spontaneously or following anti-vascular endothelial growth factor (VEGF) therapy. [ 1 ] The RPE tears are graded based on the size of the tears and the involvement of the fovea: Grade 1 tears as <200 μm, Grade 2 tears between 200 μm and 1-disc diameter, Grade 3 tears as >1-disc diameter, and Grade 4 tears as Grade 3 tears involving the center of the fovea.…”

“…[ 1 2 3 ] The RPE rip is a classical form of large RPE tear, associated with 10%–17% of AMD-related vascularized PED, developing either spontaneously or following anti-vascular endothelial growth factor (VEGF) therapy. [ 1 ] The RPE tears are graded based on the size of the tears and the involvement of the fovea: Grade 1 tears as <200 μm, Grade 2 tears between 200 μm and 1-disc diameter, Grade 3 tears as >1-disc diameter, and Grade 4 tears as Grade 3 tears involving the center of the fovea. [ 2 ] The RPE aperture is another form of RPE defect, usually of smaller size, which has been reported to complicate avascular PED in AMD.…”

Comparative Safety of Bevacizumab, Ranibizumab, and Aflibercept for Treatment of Neovascular Age-Related Macular Degeneration (AMD): A Systematic Review and Network Meta-Analysis of Direct Comparative Studies

“…When it comes to pigment epithelium tears, there have been a large number of reports describing this complication after intravitreal BVZ, RBZ and AFB therapy, almost always in eyes with vascularized pigment epithelial detachments (PED) and neovascular AMD. The pathogenesis of RPE tear formations continues to remain controversial; at the same time, it seems to be related to the size of the presenting PED at the baseline, stress on the RPE and the anti-VEGF treatment [27]. This complication may occur spontaneously or during the anti-VEGF treatment, which is considered as a risk factor, but the true extent of the treatment's contribution to the natural course of this complication is still unclear [27,28].…”

“…The pathogenesis of RPE tear formations continues to remain controversial; at the same time, it seems to be related to the size of the presenting PED at the baseline, stress on the RPE and the anti-VEGF treatment [27]. This complication may occur spontaneously or during the anti-VEGF treatment, which is considered as a risk factor, but the true extent of the treatment's contribution to the natural course of this complication is still unclear [27,28].…”