Predictors of anti-VEGF-associated retinal pigment epithelial tear using FA and OCT analysis

Retina. 2008 Oct;28(9):1265-9. doi: 10.1097/IAE.0b013e31817d5d03.

Abstract

Purpose: To identify fluorescein angiography and optical coherence tomography (OCT) predictors for retinal pigment epithelial (RPE) tear in eyes with pigment epithelium detachment (PED) associated with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor (VEGF) modulating therapy.

Design: Retrospective comparative case series.

Methods: In a single institutional center, 60 consecutive patients with PED and neovascular age-related macular degeneration treated with VEGF modulating therapy (either pegaptanib, bevacizumab, or ranibizumab) for more than a 27-month period were included in the study. Fluorescein angiography (FA) and OCT imaging was performed before and after anti-VEGF therapy. Formal statistical analysis comparing the tear group to the nontear group was performed to identify high-risk features for RPE tear.

Results: RPE tear rate for eyes with vascularized PED receiving anti-VEGF therapy was 17% (10/60). There were highly statistically significant differences in the median PED size on fluorescein angiography (greatest linear diameter) (3.2 mm versus 1.8 mm, respectively; P < 0.001) and in the median maximum PED height on OCT (394 mum versus 149 mum, respectively; P = 0.001) between the tear group and nontear group. There was also a significant difference in terms of the presence of subretinal fluid on OCT between the two groups (87.5% versus 39%, respectively; P = 0.019).

Conclusion: Large PED basal diameter and vertical height are correlated with an increased risk of developing an RPE tear after anti-VEGF therapy. Patients with large vascularized PED by fluorescein angiography and/or OCT analysis should be alerted of the risk for vision loss due to RPE tear after anti-VEGF therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Aptamers, Nucleotide / adverse effects
  • Aptamers, Nucleotide / therapeutic use
  • Bevacizumab
  • Choroidal Neovascularization / drug therapy
  • Choroidal Neovascularization / etiology
  • Female
  • Fluorescein Angiography*
  • Humans
  • Macular Degeneration / complications
  • Male
  • Predictive Value of Tests
  • Ranibizumab
  • Retinal Detachment / diagnosis*
  • Retinal Detachment / etiology
  • Retinal Perforations / chemically induced*
  • Retinal Pigment Epithelium* / blood supply
  • Retinal Vessels / pathology
  • Retrospective Studies
  • Risk Assessment / methods
  • Tomography, Optical Coherence*
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Aptamers, Nucleotide
  • Vascular Endothelial Growth Factor A
  • pegaptanib
  • Bevacizumab
  • Ranibizumab