RPE tears after intravitreal Lucentis
Reviewed by Saruban Pasu

The current hypothesis regarding retinal pigment epithelium (RPE) tears is the contraction and fibrosis in choroidal neovascularisation (CNV) tissue after anti-VEGF therapy can induce rips in the overlying RPE. This South Korean study aimed to identify the association between RPE tears and neovascular age-related macular degeneration / pigment epithelial detachment (nAMD/PED) subtype after intravitreal ranibizumab treatment and to investigate the efficacy of ranibizumab injections for nAMD patients with RPE tears. All types of PED were included without exclusion, and they were categorised as fibrovascular PED, serous PED and haemorrhagic PED according to fluorescein angiography / indocyanine green angiography (FA/ICGA) and spectral domain - optical coherence tomography (SD-OCT) findings. Four hundred and seven eyes were enrolled in the study. All patients were given a loading dose of three injections and subsequently treated on a prn basis. The mean injection numbers was 4.91±1.32 during 12 months. RPE tears developed in 32 eyes (7.9%) after treatment during the 12-month follow-up period, the majority of which (31 eyes, 96.9%) had PED at baseline. Twenty-eight of these eyes (87.5%) developed tears within three months (during the three monthly loading injections), and the others (four eyes) developed at five months, seven months, 11 months and 12 months, respectively. When comparing between the patients with RPE tears (32 eyes) and the patients without RPE tears (375 eyes), several significant differences were found for patients that went on to develop RPE tears: more frequent PED at baseline (P<0.001), worse best corrected visual acuity (BCVA) at baseline (P=0.040), higher incidence of fibrovascular PED (P=0.019), higher mean PED height (P=0.011), and infrequency of polypoidal choroidal vasculopathy (PCV) (P=0.044). At 12 months from baseline, the RPE tear group showed worse BCVA than the no RPE tear group (0.74 logMAR vs. 0.59 logMAR, P=0.014). The RPE tear group without foveal involvement showed significantly better BCVA than that of the RPE tear group with foveal involvement at 12 months (0.64 logMAR vs. 0.86 logMAR, P=0.018). – SP

Retinal pigment epithelial tear after intravitreal ranibizumab treatment for neovascular age-related macular degeneration.
Cho HJ, Kim HS, Yoo SG, et al.
RETINA
2016;36:1851-9.