Abstract

FR.21.03

Pigment epithelium (RPE) tears are a typical complication after anti-VEGF-treatment for PEDs in exsudative AMD

Matthias Gutfleisch, Max Schumacher, Britta Heimes, Georg Spital, Daniel Pauleikhof, Albrecht Lommatzsch
Augenabteilung am St. Franziskus Hospital, Münster

Objective
Pigment epithelium (RPE) tears are a typical complication after anti-VEGF-treatment for PEDs in exsudative AMD. This study analyses visual acuity and morphology of RPE tears that are associated with retinal angiomatous proliferations (RAP) and occult choroidal neovascularisation.
Methods
Monocenter, retrospective study of patiens (n=37) with RPE tears following bevacizumab (n=11), ranibizumab (n=22) and pegaptanib (n=4). treatment. We analysed best visual acuity and different morphologic aspects by means of appearance in fluorescein angiography and optical coherece tomography. Mean follow up was 88 weeks.
Results
PED was associated with occult CNV in 23 eyes (62%) and RAP in 14 eyes (38%).  RPE tears were diagnosed after 109 days (SD±100 days). Visual acuity deteriorated after a RPE tear in 35% (1 month), 47% (6 month) und 60% (12 month). Lesions diameter was larger in 33 eyes (84%) after a RPE tear. PED remained after RPE tear in all eyes. This PED was lower in 68%, higher in 20% and unchanged in 12% measured by OCT compared to the initial PED. In 35% of the eyes the fovea was located over the retracted RPE. These patients showed a significant better long term visual acuity. The RPE below the RAP was retracted in 36 % of the lesons. In occult CNV the displacement of the RPE-flap towards the vascularisation could be observed in 87%.
Conclusions
Development of RPE tears after Anti-VEGF-Therapy is associated with deterioration of visual acuity. PED often remains after therapy, implicating that discontinuation of anti-VEGF treatment might detrimental. The enlargement of lesions and the retraction of RPE towards the associated vascularisation suggests involvement of tangential stress and contraction of a regressive CNV in RPE tear development.

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