This article is more than 5 years old. Information may no longer be current.
PED, neovascular AMD associated with RPE tears after anti-VEGF injections
Click Here to Manage Email Alerts
Nearly 8% of eyes with neovascular age-related macular degeneration and fibrovascular pigment epithelial detachment developed retinal pigment epithelium tears after intravitreal ranibizumab injections, according to a Korean study.
Even though a patient with neovascular AMD is at a higher risk for development of RPE tear, intravitreal anti-VEGF treatment should not be delayed, Han Joo Cho, MD, told Ocular Surgery News.
“Pigment epithelial detachment (PED) type and neovascular AMD subtype are associated with the development of RPE tears after intravitreal ranibizumab (Lucentis, Genentech) injections. Continued ranibizumab therapy after RPE tear development can maintain visual acuity when the fovea is not involved,” he said.
The study included 407 treatment-naïve eyes of 377 patients with neovascular AMD. Each patient was treated with 3 months of injections, followed by further injections as needed.
At final follow up, 32 eyes (7.9%) developed RPE tears, 96% of which had PED at baseline. Twenty-five eyes developed RPE tears from fibrovascular PEDs, five eyes from hemorrhagic PEDs and two eyes from serous PEDs.
Additionally, 25 eyes with typical neovascular AMD developed RPE tears, three eyes with polypoidal choroidal vasculopathy developed tears, and four eyes with retinal angiomatous proliferation developed tears.
“These results might be associated with RPE tear formation mechanisms after intravitreal anti-VEGF injections. Currently, one theory proposes that anti-VEGF therapy may cause [choroidal neovascularization] contraction and fibrosis, which rips the overlying RPE. In addition, neovascular tissue adherent to the undersurface of the RPE may impart a substantial contractile force. Thus, considering the relatively small amount of CNV overlying or underlying the RPE layer in serous PED, fibrovascular PED might be more vulnerable to the tensile strength secondary to CNV contracture,” Cho said.
Regarding neovascular AMD subtype, Cho said it has been reported that PED formation in polypoidal choroidal vasculopathy was derived from polypoidal lesions.
“When the size of the polyp is small or they do not extend to the RPE layer of the PED, polyp regression after intravitreal anti-VEGF injection may not generate sufficient tensile strength for RPE tear formation; thus, the probability of RPE tear might be relatively lower than typical [neovascular] AMD or [retinal angiomatous proliferation],” he said.
Continued ranibizumab injections did not improve best corrected visual acuity in RPE tear patients at 12 months. BCVA in patients without RPE tear who received ranibizumab showed statistically significant improvement throughout the 12-month follow-up.
However, RPE tear patients without fovea involvement who received intravitreal ranibizumab injections showed significant BCVA improvement from baseline to 12 months compared with patients with fovea involvement.
Despite neovascular AMD patients having a higher risk for development of RPE tears, Cho said anti-VEGF treatments should not be delayed and clinicians should counsel patients at high risk of RPE tears before treatment begins. – by Robert Linnehan
- Reference:
- Cho HJ, et al. Retina. 2016;doi:10.1097/IAE.0000000000001009.
- For more information:
- Han Joo Cho, MD, can be reached at Department of Ophthalmology, Kim’s Eye Hospital, 156, 4ga, Yeoungdeungpodong, Yeoungdeungpo-gu, Seoul, South Korea; email: chojoo@kimeye.com.
Disclosure: Cho reports no relevant financial disclosures.