Predictors of anti-VEGF-associated retinal pigment epithelial tear using FA and OCT analysis

To identify fluorescein angiography and optical coherence tomography (OCT) predictors for retinal pigment epithelial (RPE) tear in eyes with pigment epithelium detachment (PED) associated with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor (VEGF) modulating therapy.

Retrospective comparative case series.

In a single institutional center, 60 consecutive patients with PED and neovascular age-related macular degeneration treated with VEGF modulating therapy (either pegaptanib, bevacizumab, or ranibizumab) for more than a 27-month period were included in the study. Fluorescein angiography (FA) and OCT imaging was performed before and after anti-VEGF therapy. Formal statistical analysis comparing the tear group to the nontear group was performed to identify high-risk features for RPE tear.

RPE tear rate for eyes with vascularized PED receiving anti-VEGF therapy was 17% (10/60). There were highly statistically significant differences in the median PED size on fluorescein angiography (greatest linear diameter) (3.2 mm versus 1.8 mm, respectively; P < 0.001) and in the median maximum PED height on OCT (394 mum versus 149 mum, respectively; P = 0.001) between the tear group and nontear group. There was also a significant difference in terms of the presence of subretinal fluid on OCT between the two groups (87.5% versus 39%, respectively; P = 0.019).

Large PED basal diameter and vertical height are correlated with an increased risk of developing an RPE tear after anti-VEGF therapy. Patients with large vascularized PED by fluorescein angiography and/or OCT analysis should be alerted of the risk for vision loss due to RPE tear after anti-VEGF therapy.