Department of Ophthalmology, St Franziskus Hospital, Muenster, Germany.
Eye (Lond). 2011 Sep;25(9):1181-6. doi: 10.1038/eye.2011.146. Epub 2011 Jun 24.
Retinal pigment epithelium (RPE) tears may develop as a complication after anti-VEGF (vascular endothelial growth factor) treatment for pigment epithelial detachments (PEDs) in exudative age-related macular degeneration (AMD). This retrospective study analyses best-corrected visual acuity (BCVA) and foveal involvement after RPE tears that are associated with anti-VEGF therapy due to PED in exudative AMD.
A total of 37 patients with RPE tears during anti-VEGF therapy (bevacizumab 12, ranibizumab 21 and pegaptanib 4 eyes) for progressive PED in AMD (PED with occult choroidal neovascularization 25 eyes and PED with retinal angiomatous proliferation 12 eyes) were included in this study. We analyzed BCVA and different morphologic aspects by means of appearance on fluorescein angiography and optical coherence tomography. Mean follow-up was 88 weeks.
RPE tears were diagnosed a mean of 56 days after the first injection. BCVA deteriorated after RPE tear and during follow-up significantly (P<0.001), with 53.2% of eyes being legally blind (WHO, world health organization) at 12 months. RPE-free foveal area, foveal wrinkling of the RPE, and fibrotic scar development were significantly associated with worse visual acuity.
RPE tears can be observed in 12-15% of treated eyes during anti-VEGF therapy for PED in exudative AMD. Owing to the close time relationship with the therapy, this complication must be taken into consideration. Visual prognosis is associated with a decrease in vision in the long term, often resulting in a severe visual disability. Relevant factors for a negative visual prognosis were the potential foveal involvement of the central RPE and morphologic fibrovascular transformation of the RPE tear.
在湿性年龄相关性黄斑变性（AMD）的色素上皮脱离（PED）接受抗血管内皮生长因子（VEGF）治疗后，可能会出现视网膜色素上皮（RPE）撕裂等并发症。本回顾性研究分析了与抗 VEGF 治疗相关的 RPE 撕裂对渗出性 AMD 中 PED 患者最佳矫正视力（BCVA）和中心凹受累的影响。
共纳入 37 例接受抗 VEGF 治疗（贝伐单抗 12 例、雷珠单抗 21 例和帕尼单抗 4 例）的患者，这些患者在治疗过程中均出现了 RPE 撕裂，并且这些 RPE 撕裂与 AMD 中的 PED 相关（PED 合并隐匿性脉络膜新生血管 25 例和 PED 合并视网膜血管瘤样增生 12 例）。我们通过荧光素血管造影和光学相干断层扫描分析了 BCVA 和不同形态特征。平均随访时间为 88 周。
RPE 撕裂平均在首次注射后 56 天诊断。RPE 撕裂后和随访期间 BCVA 显著恶化（P<0.001），12 个月时 53.2%的眼为法定盲（世界卫生组织）。RPE 无裂孔的中心凹区域、RPE 皱襞和纤维化瘢痕的形成与视力下降显著相关。
在渗出性 AMD 接受抗 VEGF 治疗的 PED 患者中，12-15%的治疗眼可观察到 RPE 撕裂。由于与治疗的时间关系密切，必须考虑到这种并发症。长期视力预后与视力下降相关，常导致严重的视力障碍。视力预后不良的相关因素是中央 RPE 的潜在中心凹受累和 RPE 撕裂的形态学纤维血管转化。
