Larger pigment epithelial detachments at higher risk of RPE tears after anti-VEGF therapy Researchers report that patients with larger pigment epithelial detachments are at highest risk for RPE tear after anti-VEGF therapy

Investigators retrospectively studied the records of 60 consecutive patients with pigment epithelium detachment (PED) and neovascular age-related macular degeneration (wet AMD) treated with either Lucentis, Avastin, or Macugen. Fluorescein angiography and optical coherence tomography imaging was performed before and after anti-VEGF therapy.

The RPE tear rate for eyes with PED receiving anti-VEGF therapy was 17% (10/60). Comparing eyes that developed RPE tears with eyes that did not develop tears, the average size (greatest linear diameter) of the PED on fluorescein angiography was significantly larger among eyes that developed tears (3.2 mm versus 1.8 mm). There were also significant differences in the average PED height on OCT (394 um versus 149 um) and the presence of subretinal fluid on OCT (87.5% versus 39%) between the tear group and nontear groups.

The scientists conclude that large PED diameter and vertical height are strongly correlated with an increased risk of developing an RPE tear after anti-VEGF therapy. Patients with large PEDs should be informed of the risk for vision loss due to RPE tear after anti-VEGF therapy.

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Retina. 28(9):1265-1269, October 2008.