Retinal pigment epithelium tear after intravitreal bevacizumab for exudative age-related macular degeneration

PURPOSE: To report on the development of retinal pigment epithelium tears after intravitreal injections of bevacizumab as treatment of exudative age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: The study included 63 patients who received an intravitreal injection of 1.5 mg bevacizumab as treatment of a detachment of the retinal pigment epithelium attributable to AMD and who had a follow-up of at least two months. RESULTS: Four patients (6%) developed a tear of the retinal pigment epithelium in the parafoveal region. Compared with the baseline value, visual acuity at the end of follow-up remained stable in three patients and declined in the fourth patient. CONCLUSIONS: Intravitreal injections of bevacizumab may be followed by a tear of the retinal pigment epithelium in eyes with exudative AMD and a retinal pigment epithelium detachment.     

Retinal pigment epithelial tear after intravitreal bevacizumab injection

PURPOSE: To report two cases of a retinal pigment epithelial (RPE) tear after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). DESIGN: Observational case series. METHODS: Two patients presented with occult choroidal neovascularization secondary to AMD. Both patients received intravitreal bevacizumab injections. RESULTS: The first patient developed a RPE tear shortly after a third intravitreal bevacizumab injection. The second patient developed a RPE tear 10 days after a second intravitreal bevacizumab injection. CONCLUSIONS: Although RPE tears may occur spontaneously as part of the natural history of exudative AMD, patients may develop visually devastating RPE tears after repeat intravitreal bevacizumab injection. Further studies are needed to determine the incidence of RPE tears after intravitreal bevacizumab injections.     

Retinal pigment epithelial tear following intravitreal pegaptanib sodium

PURPOSE: To report two cases of a retinal pigment epithelial tear after intravitreal injection of pegaptanib sodium. To our knowledge, this is the first report of this finding after intraocular antivascular endothelial growth factor therapy. DESIGN: Observational case reports. METHODS: Two patients presented with occult choroidal neovascularization and associated serous pigment epithelial detachment that was a result of age-related macular degeneration. Both patients were treated with an intravitreal injection of pegaptanib sodium. RESULTS: One patient developed a retinal pigment epithelium tear one week after the intravitreal injection. The second patient developed a retinal pigment epithelium tear eight weeks after treatment. CONCLUSIONS: Although these cases may represent natural history, there should be a high index of suspicion for retinal pigment epithelium tears in patients who report significant visual deterioration after intravitreal injection of pegaptanib sodium. Further studies are needed to determine whether angiographic subtypes of choroidal neovascular membranes are more susceptible to developing retinal pigment epithelium tears after treatment with antivascular endothelial growth factor agents.     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for predominantly classic choroidal neovascularization

PURPOSE: To detect retinal pigment epithelium (RPE) tears in predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with intravitreal bevacizumab injections. METHODS: Forty consecutive patients with predominantly classic CNV secondary to AMD were treated with 1.25 mg of intravitreal bevacizumab. Patients were evaluated with visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography. RESULTS: Three patients developed a RPE tear after the first injection. The first patient had been treated with verteporfin therapy and VA remained unchanged. In the other two cases the CNV was naive and VA improved since the foveal center was not involved by the tear and macular edema was reduced. CONCLUSIONS: RPE tears can occur following intravitreal bevacizumab injections in patients with predominantly classic CNV although VA is not always affected.     

Retinal pigment epithelial tear after ranibizumab therapy for subfoveal fibrovascular pigment epithelial detachment

PURPOSE: To describe the unusual complication of retinal pigment epithelial (RPE) tear after intravitreal ranibizumab (Lucentis) for subfoveal fibrovascular pigment epithelial detachment (PED) and its effective management. METHODS: Chart review for case report of RPE tear after ranibizumab. RESULTS: An inferior RPE tear was documented by fluorescein angiography, fundus photography, and optical coherence tomography (OCT) 1 month after receiving repeat ranibizumab injection in the right eye of a patient with bilateral subfoveal fibrovascular PED. He had undergone multiple bevacizumab followed by ranibizumab injections for neovascular age-related macular degeneration (AMD) in both eyes, starting 6 months previously. Subsequent antivascular endothelial growth factor (VEGF) therapy improved vision of right eye from 20/200 to 20/40, despite RPE tear. CONCLUSIONS: RPE tear may form after anti-VEGF therapy, including ranibizumab injection. Further anti-VEGF therapy may preserve or improve vision. To the authors' knowledge, this is first case report of effective suppression of neovascular activity with bevacizumab after an RPE tear following ranibizumab therapy.     

Retinal pigment epithelial tear after intravitreal ranibizumab for subfoveal CNV secondary to AMD

Purpose To report a case of retinal pigment epithelial tear following intravitreal ranibizumab injection for subfoveal choroidal neovascularization. Methods Retrospective single case review. Results A 78-year-old Caucasian female was treated with intravitreal ranibizumab for occult subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD). She returned for evaluation with decreased vision and was found to have a retinal pigment epithelial tear on biomicroscopy. Fluorescein angiography and OCT testing confirmed the clinical findings. Conclusion Although a pigment epithelial tear in neovascular AMD can represent natural history, prior reports of such tears after thermal laser, photodynamic therapy with verteporfin and following intravitreal injection of pegaptanib Na combined with this case report suggest that clinicians should be aware of and monitor patients for the possibility of this complication after intravitreal injections of ranibizumab.     

Retinal pigment epithelium tears after intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration

BACKGROUND: Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab. METHODS: In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate. RESULTS: Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%. CONCLUSIONS: RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.     

Spontaneous rip of the retinal pigment epithelium with a macular hole in neovascular age-related macular degeneration

PURPOSE: To report a case of retinal pigment epithelial tear associated with a macular hole in a patient with neovascular age-related macular degeneration (AMD). DESIGN: Observational case report. METHODS: An 87-year-old woman with AMD-related fibrovascular pigment epithelial detachment associated with vision loss was followed with sequential fundus photography, fluorescein angiography, and optical coherence tomography for 8 months. RESULTS: The detachment developed into a retinal pigment epithelium tear with macular hole formation. The temporal evolution of the lesion and optical coherence tomography findings suggested that the retinal pigment epithelium tear led to stretching forces along the posterior surface of the neurosensory retina with secondary foveal dehiscence. CONCLUSION: Macular hole formation is one mechanism by which retinal pigment epithelium tears may cause vision loss in AMD.     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for exudative age-related macular degeneration

We report a series of retinal pigment epithelial (RPE) tears after intravitreal bevacizumab therapy for choroidal neovascularization associated with age-related macular degeneration (ARMD). Retinal pigment epithelial tears were estimated to occur at an incidence of 1.6% in this patient population at our institution. Ophthalmologists should be aware of this rare but serious finding associated with exudative macular degeneration therapy.     

Retinal pigment epithelium tears following verteporfin therapy combined with intravitreal triamcinolone

PURPOSE: To detect patients with neovascular age-related macular degeneration (AMD) who experience retinal pigment epithelium tears after initial verteporfin therapy combined with intravitreal triamcinolone during early follow-up. DESIGN: Prospective interventional case series. METHODS: Forty-five consecutive patients with choroidal neovascularization (CNV) in AMD were treated with verteporfin therapy combined with 4 mg of intravitreal triamcinolone. Optical coherence tomography (OCT), visual acuity, and fluorescein angiography were performed. RESULTS: Two eyes with a predominantly classic CNV developed a retinal pigment epithelium tear. An early onset tear could be differentiated from a delayed onset tear. OCT showed an increased depth signal in areas of missing retinal pigment epithelium and a wavy, contracted, and elevated retinal pigment epithelium band. CONCLUSIONS: Retinal pigment epithelium tears can occur despite adding intravitreal triamcinolone to verteporfin therapy. OCT shows characteristic changes in the evolution of retinal pigment epithelium tears after combination therapy.     

Retinal pigment epithelium tears following intravitreal ranibizumab therapy

Two patients with choroidal neovascularization secondary to age-related macular degeneration (AMD) developed a retinal pigment epithelial (RPE) tear following intravitreal injection of ranibizumab. One patient developed the RPE tear within 2 weeks of the injection, the other within 6 weeks of a second injection. Both patients presented with vision loss of one line at diagnosis of the RPE tear. During long-term follow-up, visual acuity improved in one patient by one line and deteriorated in the second patient by three lines. RPE tears may occur after intravitreal injection of ranibizumab in patients with neovascular AMD, probably because of the rapid regression of the fibrovascular membrane.     

Serous Retinal Detachment Following Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection

We report a case of serous retinal detachment following combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in subfoveal choroidal neovascularization (CNV).A 53-year-old woman was diagnosed with subfoveal CNV secondary to age-related macular degeneration (AMD) and treated with combined PDT and intravitreal bevacizumab injection. One day after treatment, the patient experienced a sudden decline of vision and optical coherence tomography (OCT) showed serous retinal detachment involving the macula. She was managed conservatively with an oral steroid beginning on the second day of the combined treatment and the subretinal fluid started to decrease one week following the initiation of steroids.This case suggests that combined PDT and intravitreal injection of bevacizumab can be associated with serous retinal detachment. Additional studies are needed to establish the safety and complications following this treatment regimen.     

Retinal pigment epithelial tear after intravitreal ranibizumab

PURPOSE: To report two cases of a retinal pigment epithelial (RPE) tear after intravitreal injection of 0.05 mg ranibizumab. DESIGN: Observational case report. METHODS: Two patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD) were treated with an intravitreal injection of ranibizumab. RESULTS: Both patients were found to have a RPE tear on follow-up visits at one month, confirmed by optical coherence tomography (OCT) and by fluorescein or indocyanine green angiography. CONCLUSIONS: RPE tears may occur after intravitreal injection of ranibizumab. Further study is needed to determine whether CNV membranes associated with pigment epithelial detachments (PED) are more likely to develop RPE tears after treatment with anti-vascular endothelial growth factor (anti-VEGF) agents.     

Intravitreale Anti-VEGF-Therapie mit Bevacizumab bei neovaskulärer AMD

PURPOSE: To report on the efficacy of intravitreal bevacizumab as off-label therapy in different angiographic subtypes in neovascular age-related macular degeneration (AMD). METHODS: Seventy-five patients with neovascular AMD and recent disease progression were classified into different angiographic subtypes and were treated with intravitreal bevacizumab (1.25 mg/0.05 ml) at 6-week intervals. Patients with subfoveal classic choroidal neovascularization (CNV) also received photodynamic therapy. ETDRS visual acuity, ophthalmic exams, and optic coherence tomography (OCT) were performed before treatment, 1 week after treatment, and then on a 6-week basis. Fluorescein angiographies and medical check-ups were also done. RESULTS: Bevacizumab led to stabilization of visual acuity (loss of less than 15 letters) in all angiographic subtypes during a follow-up of 37+/-13 weeks. Patients with occult extrafoveal CNV (n=6) profited the most and gained 2+/-2 lines. Treatment with intravitreal bevacizumab was very well tolerated in all patients, with neither systemic nor intraocular side effects, with the exception of one retinal pigment epithelium tear. CONCLUSION: Intravitreal bevacizumab treatment is efficacious in all angiographic CNV subtypes and leads to reduction of macular edema and stabilization or improvement in visual acuity.     

Macular translocation with 360° retinotomy for retinal pigment epithelial tear

PURPOSE: To report a case of retinal pigment epithelial tear treated by macular translocation with 360 degrees retinotomy. METHODS: Interventional case report. A 75-year-old woman with neovascular age-related macular degeneration and retinal pigment epithelial tear underwent macular translocation with 360 degrees retinotomy and silicone oil tamponade. After 3 months, pars plana vitrectomy, silicone oil removal, and muscle surgery were performed. RESULTS: Twenty-two months after macular translocation surgery, the visual acuity of the patient had improved to 20/50 (preoperative 20/200). No proliferative vitreoretinopathy or recurrence of the choroidal neovascularisation was observed. CONCLUSIONS: Macular translocation surgery with 360 degrees retinotomy can improve vision in retinal pigment epithelial tear secondary to neovascular age-related macular degeneration.     

Bevacizumab for occult subfoveal neovascularization in age-related macular degeneration

PURPOSE: To report on the treatment of exudative age-related macular degeneration by intravitreal bevacizumab (Avastin). METHODS: A 78-year-old patient experienced a progressive loss of visual acuity in her right eye due to an occult subfoveal neovascular membrane in age-related macular degeneration. She received an intravitreal injection of 1.5 mg bevacizumab. RESULTS: Within 4 weeks after the injection, visual acuity improved from 0.40 to 0.60 with complete resolution of subretinal and intraretinal leakage and edema as shown on optical coherence tomography. Pre-existing metamorphopsias disappeared. Intraocular pressure remained in the normal range. During the follow-up, there were no sings of intraocular inflammation or any other intraocular pathology induced by the intravitreal injection. CONCLUSIONS: Intravitreal bevacizumab may potentially be helpful in the treatment of exudative age-related macular degeneration and may deserve further evaluation.     

Riss des retinalen Pigmentepithels durch intravitreale Aflibercept-Injektion

Development of tears in the retinal pigment epithelium (RIP) has been described as a possible complication following anti-vascular endothelial growth factor (VEGF) antibody therapy with substances which have been available for years when treating pigment epithelium detachment (PED) in eyes affected by age-related macular degeneration (AMD). Aflibercept has become available for the treatment of exsudative AMD since December 2012. This case report describes a further patient in addition to the only other case published so far who developed RIP after aflibercept treatment for PED. Patients have to be thoroughly informed about this potential side effect before initiation of intravitreal aflibercept injection therapy.     

Retinal pigment epithelium tears after intravitreal bevacizumab in pigment epithelium detachment

PURPOSE: To evaluate pigment epithelium detachment (PED) secondary to exudative age-related macular degeneration (AMD) treated with intravitreal injection of bevacizumab with regard to incidence of retinal pigment epithelium tears (RIPs). DESIGN: Retrospective, interventional case series. METHODS: Institutional study of 31 eyes with PED in exudative AMD receiving intravitreal bevacizumab. Main outcome measures were Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, PED vascularization and size measured by angiography and optical coherence tomography (OCT) imaging, and incidence of RIP. RESULTS: Vision improved in six eyes and remained stable in 22 eyes (follow-up, 12.3 +/- 10.3 weeks). Twenty-eight eyes showed a vascularized PED. Four eyes (12.9%) experienced an RIP without vision loss. All RIP cases were vascularized in more than 50% of total lesion size. CONCLUSIONS: In short-term follow-up, the risk for RIP after bevacizumab injection in eyes with PED seems to be moderately, but not statistically significantly, increased in PED lesions vascularized more than 50%.     

Rapid response to intravitreal aflibercept in neovascular age-related macular degeneration after development of tachyphylaxis to bevacizumab and ranibizumab

This article reports a rapid response of intravitreal aflibercept for the treatment of a case of neovascular age-related macular degeneration that developed tachyphylaxis to bevacizumab and ranibizumab. An 80-year-old man with neovascular age-related macular degeneration became unresponsive to monthly treatment with bevacizumab or ranibizumab after initial responsiveness, to as-needed treatment with these antivascular endothelial growth factor drugs for 49 months. Subretinal fluid and pigment epithelial detachment had sustained in spite of 14 bevacizumab and seven ranibizumab injections prior to intravitreal aflibercept treatment. After only one injection of intravitreal aflibercept, a marked improvement was seen within 1 week. Complete drying of subretinal fluid and marked subsidence of pigment epithelial detachment were noted 4 weeks after the first aflibercept injection and sustained for three consecutive monthly injections. This case reveals that shifting to aflibercept may be an effective alternative treatment for neovascular age-related macular degeneration that becomes tachyphylactic to bevacizumab or ranibizumab.     

Retinal pigment epithelial tear following intravitreal ranibizumab injections for neovascular age-related macular degeneration

Background To report the development of retinal pigment epithelial (RPE) tear after intravitreal injection of ranibizumab (Lucentis, Novartis, Basel, Switzerland). Methods Case report with presentation of the fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) findings. Results A 70-year-old man received intravitreal injections of ranibizumab for the treatment of occult choroidal neovascularisation (CNV) with fibrovascular pigment epithelial detachment due to age-related macular degeneration. One day after the third intravitreal ranibizumab injection, fundus examination showed a RPE defect at the foveal region. FA and OCT confirmed the presence of RPE tear sparing the fovea. No further progression of the RPE tear was observed after withholding subsequent ranibizumab injection and his right eye visual acuity remained at 20/100 at 3 months from the last injection. Conclusions As with other anti-vascular endothelial growth factor treatment for CNV, RPE tear might occur after intravitreal ranibizumab injection even after previous uneventful intravitreal injections.