Abstract

P 274

Successfull treatment with intravitreal Lucentis in spite of pigment epithelium tear

Jens Huber, Nikolaus Feucht, Matthias Maier, Chris P. Lohmann
Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, München

Objective
Intravitreal anti-VEGF-Injection shows a very good safety profil. Nevertheless in eyes with serous detachment of the retinal pigment epithelium (PED) the risk of developing retinal pigment epithelium tears (RIP) is described with 5-20%. In case of foveal involvement visual acuity declines unrecoverable.
We demonstrate a succesfull therapy with intravitreal Lucentis in spite of appearance of retinal pigment epithelium tear in patient suffering from fibrovascular PED.
Methods
case report
Diagnosis and follow up investigation including biomicroscopy of the retina, fundus photography, central retinal thickness (SpectralisOCT, Heidelberg Engeneering) and fluorescein angiography. Saturation phase, including 3 intravitreal injections in time-lag of 4 weeks to each injections. 
Results
The described patient showed a fibrovascular PED in initial diagnosis. Visual acuity at first visit was reduced to 0,8 (dec).
After saturation phase the patient showed appearance of RIP without subjective impaired vision. Foveal retinal pigment epithelium remained uninvolved.  Visual acuity increased to 1,0 (dec).
Due to the activity of CNV, the intravitreal treatment with Lucentis was continued with additional 3 intravitreal injections of Lucentis.
Follow up investigation after 6 months showed a decrease of activity in fluorescein angiography. Visual acuity stabilazed at 1,0 (dec).
Conclusions
The lost of visual acuity in case of RIP depends on the position and foveal involvement. In case of extrafoveal position intravitreal therapy can reach stabilization, or as decribed, even increasement of the visual acuity. We suggest therapeutic efficiency of intravitreal treatement with Lucentis in appearance of RIP. Therefore intravitreal anti-VEGF-therapy should be continued in case of CNV acitivity.

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