Abstract:

Objective To evaluate the characteristic factors for retinal pigment epithelial (RPE) tears in patients with fibrovascular retinal pigment epithelial detachment (fv-RPED) after anti-vascular endothelial growth factor (VEGF) therapy. Methods A total of 76 patients (76 eyes) diagnosed with fv-RPED and received anti-VEGF treatment were enrolled. Patients were divided into the tear group (9 cases) and the non-tear group (67 cases) according to the occurrence of RPE tears. Data of types of anti-VEGF drugs received by patients with RPE tear, the number of injections before the tear and the interval time from the last injection to the RPE tear were collected. Best-corrected visual acuity (BCVA) was recorded at the last visit before the tear and at the first visit after the tear. Optical coherence tomography (OCT) was used to measure the height and maximum horizontal diameter of fv-RPED in all patients before treatment, and the imaging features of patients with RPE tear before treatment were analyzed. Results Age, fv-RPED height and maximum horizontal diameter were significantly higher in the tear group than those in the non-tear group (all P<0.05). Among the 9 patients with RPE tears, the anti-VEGF agents administered included ranibizumab 0.5 mg (3 cases), conbercept 0.5 mg (4 cases), aflibercept 2 mg (1 case) and aflibercept 8 mg (1 case). The mean number of injections before the tear was 3.5±1.2. Six tears occurred during the initial three loading doses, and three occurred during the reactivation phase. The median interval from the last injection to the RPE tear was 21 days. The mean ETDRS letter score decreased from 59.1±4.4 before the tear to 37.6±8.4 after the tear (P<0.05). All 9 cases showed obvious RPE folds. A hyporeflective cleft beneath the RPE-choroidal neovascularization (CNV) complex was observed in 5 cases, and RPE microrips were present in 2 cases. Conclusion Risk factors for RPE tears in fv-RPED patients after anti-VEGF treatment include advanced age, larger fv-RPED dimensions, and OCT features such as RPE folds, a hypo-reflective cleft beneath the RPE-CNV complex and RPE micro-rips.

Key words: vascular endothelial growth factors, tomography, optical coherence, retinal pigment epithelial tear, fibrovascular retinal pigment epithelial detachment