Optical coherence tomography (OCT) angiomatous prolifieration (RAP) in retinal

PURPOSE: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD). METHODS: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA). RESULTS: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization. CONCLUSIONS: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.     

渗出型老年黄斑变性患者眼底相干光断层成像结果分析

目的：了解渗出型老年黄斑变性（age-related macular degeneration,AMD）患者的眼底相干光断层成像（optical coherence tomography,OCT）特征。方法：对经常规检查、荧光素眼底血管造影（fundus fluorescein angiography,FFA）、吲哚青绿脉络血管造影（indocyanine green angiography,ICGA）确诊的渗出型AMD患者38例（42只眼）行眼底OCT检查,分析其图像资料,并与其FFA和ICGA检查结果进行比较。结果：OCT图像特征：典型纤维性新生血管膜34只眼,浆液性视网膜神经上皮脱离38只眼,视网膜神经纤维层脱离合并层间水肿8只眼,出血性和浆液性视网膜色素上皮（retinal pigment epithelium,RPE）脱离分别为11只眼和9只眼。结论：渗出型AMD患者眼底OCT图像特征为典型的纤维性新生血管膜合并浆液性视网膜神经上皮脱离、视网膜神经纤维层脱离、浆液性和出血性RPE脱离。上述图像特点证实和补充了FFA和ICGA检查结果,有助于渗出型AMD的诊断和评价。     

Characteristics of Indocyanine Green Angiography in Exudative Age—related Macular Degeneration

Objective: To observe the characteristics of indocyanine green angiography (ICGA) in exudative age-related macular degeneration (AMD).Methods: Thirty-one cases (39 eyes) were diagnosed as exudative AMD by ocular examination, fundus color photography, fundus fluorescein angiography (FFA) and ICGA. Their ages ranged from 50 to 82 years and visual acuities from FC/30cm to 0. 7. We analyzed and compared the characteristics of ICGA and FFA in these patients. Results: Of 26 eyes with occult choroidal neovascularization (CNV) by FFA, 15 (57. 7% ) had classic CNV by ICGA. Of 4 eyes with serous retinal pigment epithelial detachment (FED) without CNV by FFA, 1 had serous FED with classic CNV by ICGA. The hyperfluorescence of the scar staining was detecfed by ICGA. Conclusion ? ICGA adds clinically useful information and is an important adjunct in the evaluation, classification, and laser treatment of patients with occult CNV in AMD. Eye Science 1999; 15: 156 - 161.     

渗出型老年性黄斑变性的光学相干断层扫描观察

目的 观察渗出型老年性黄斑变性(age-related macular degeneration,AMD)的光学相干断层扫描(optical coherence tomography,OCT)图像特征。 方法 对荧光素眼底血管造影(fundus fluorescein angiography,FFA)确诊的16例渗出型AMD患者的19只患眼作OCT检查,其中4例6只眼并进行吲哚青绿血管造影(indocyanine green angiography, ICGA)检查。对其彩色眼底像、FFA、ICGA和OCT图像资料进行比较。 结果 与FFA、ICGA检查结果比较,AMD患眼的OCT改变主要有：①浆液性神经上皮脱离和层间水肿11只眼;②视网膜层间出血2只眼;③浆液性色素上皮脱离5只眼;④出血性色素上皮脱离10只眼;⑤瘢痕性脉络膜新生血管(choroidal neovascularization,CNV)4只眼;⑥纤维血管膜性色素上皮脱离和隐匿型 CNV 12只眼。 结论 OCT从断面上观察和诊断渗出型AMD病变,对FFA、ICGA有补充作用。(中华眼底病杂志,2000,16:220-223)     

Neovascularization Associated with Large Retinal Pigment Epithelial Detachment in Elderly Korean Patients: Subdivision According to Indocyanine Green Angiographic Features

PURPOSE: In Korean patients, to subdivide the neovascular forms of age-related macular degeneration (AMD) associated with large retinal pigment epithelial detachment (PED), according to the indocyanine green angiographic features. METHODS: Indocyanine green angiograms (ICGA) of 67 elderly patients (72 eyes) who presented with a PED of at least 1 disc diameter were evaluated retrospectively. RESULTS: Polypoidal choroidal vasculopathy (PCV) and typical choroidal neovascularization (CNV)-associated PEDs were identified in 18 eyes (25%) and 19 eyes (26%), respectively. In ten eyes (13.9%), the exact type of neovascularization, whether PCV or CNV, could not be determined. Pure serous PEDs were identified in seven eyes (10%). The remaining 18 eyes (25%) were classified as having retinal angiomatous proliferation (RAP)-associated PED based upon the angiographic findings of vascular connections between the retinal vasculature and the neovascular complex. CONCLUSIONS: Three subset groups of PCV, CNV, and RAP were present with similar frequency in neovascularized AMD with a large PED in these Korean patients. In particular, RAP, previously thought to be rare in Asian patients, was found to be present with considerable frequency.     

渗出型老年黄斑变性的吲哚青绿血管造影特征

目的 观察渗出型老年黄斑变性(age-related macular degeneration,AMD)的吲哚青绿血管造影(indocyanine green angiography,ICGA)特征。 方法 诊断为渗出型AMD的患者31例(39只眼)，年龄50～82岁，视力范围：指数/30cm～0.7,全部完成了眼部检查、眼底彩色照相、眼底荧光素血管造影(fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)，分析和比较FFA和ICGA图像特征。 结果 FFA诊断为隐匿性脉络膜新生血管(choroidal neovascularization,CNV)的26只眼中，ICGA诊断为典型CNV有15眼，占57.7%。FFA诊断为浆液性色素上皮脱离(不伴CNV)4只眼中，有1只眼ICGA诊断为浆液性色素上皮脱离伴典型CNV。FFA和ICGA对瘢痕组织诊断的眼数及特性相近。 结论 与FFA相比，ICGA可提高对AMD典型性CNV的诊断率，扩大对AMD的治疗范围。(中华眼底病杂志,1998,14:76-80)     

Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation

PURPOSE: To determine the nature and risk of neovascularization in the fellow eyes of patients with unilateral retinal angiomatous proliferation (RAP), a neovascular form of age-related macular degeneration (AMD). METHODS: A consecutive series of 52 patients diagnosed with unilateral RAP were studied retrospectively. Clinical biomicroscopic examination, fluorescein angiography, and indocyanine green angiography were used to evaluate all patients for the development of neovascular manifestations in the fellow eye. RESULTS: Neovascularization developed in the fellow eye in 52 patients over the follow-up period (range, 2-36 months). All patients developed neovascular manifestations of RAP in the fellow eye. Twenty-one patients (40%) developed a RAP lesion within 1 year; 29 (56%), within 2 years; and 52 (100%), within 3 years. At the time of diagnosis of neovascularization in the fellow eye, 8 patients (15%) had a stage I RAP lesion, 36 (70%) had a stage II RAP lesion, and 8 (15%) had a stage III RAP lesion. Other characteristic findings in these patients included the presence of preretinal, intraretinal, and subretinal hemorrhages in 49 patients (94%) and pigment epithelial detachments in 41 patients (79%). CONCLUSIONS: In patients diagnosed with unilateral RAP lesions, the form of neovascularization that develops in the fellow eye is virtually always RAP. The annual and accumulative risk of neovascularization in the fellow eye is higher in patients with RAP than in those with other forms of neovascular AMD. These new findings enhance our understanding of the clinical spectrum of RAP in terms of its natural course and visual prognosis and may possibly offer useful information to establish future treatment options.     

Ranibizumab for retinal angiomatous proliferation in neovascular age-related macular degeneration

Background To report the efficacy of intravitreal injection of ranibizumab (Lucentis) in the treatment of retinal angiomatous proliferation (RAP) in neovascular age-related macular degeneration (AMD). Methods Case review of four consecutive patients who received 3 injections at monthly intervals of intravitreal ranibizumab injections for RAP. The serial changes in best-corrected visual acuity (BCVA), optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) are presented. Results The baseline mean logMAR BCVA was 0.89 (Snellen equivalent of 20/155). After three injections of ranibizumab, all four patients had visual improvement and the mean logMAR BCVA improved to 0.59 (Snellen equivalent of 20/78). The mean visual improvement was 3.0 lines. All patients also had complete resolution of subretinal fluid after treatment, and the mean OCT central foveal thickness reduced from 438 μm at baseline to 169 μm at 3 months. Follow-up FA and ICGA at 3 months showed absence of leakage in three patients with minimal leakage in the remaining patient. One patient had recurrence of RAP at 8 months after commencement of treatment, and repeat ranibizumab injection resulted in resolution of the subretinal fluid and pigment epithelial detachment and visual improvement. Conclusions Intravitreal ranibizumab injections appeared to be an effective treatment for RAP, resulting in visual gain and reduction in macular thickness. Further long-term studies to evaluate the efficacy of intravitreal ranibizumab in RAP are warranted.     

Surgical ablation of retinal angiomatous proliferation

Age-related macular degeneration (AMD) remains the leading cause of visual loss in adults older than 65 years. Retinal angiomatous proliferation (RAP) is a newly recognized manifestation of exudative AMD that has a poor natural history and demonstrated resistance to treatment with conventional laser photocoagulation. A novel surgical technique has been developed in this pilot series that shows promise in the treatment of this subtype of neovascular lesions. Through specific surgical lysis of the feeding arteriole and draining venule of an RAP lesion, improvement in visual acuity has been noted. This has been correlated with resolution of intraretinal edema and flattening of associated pigment epithelial detachment, which was confirmed by fluorescein angiography, optical coherence tomography, and high-speed indocyanine green angiography.     

渗出型老年性黄斑变性的吲哚青绿血管造影观察

目的观察渗出型老年性黄斑变性(AMD)的吲哚青绿血管造影(ICGA)特征.方法对27例(32只眼)渗出型AMD行ICGA造影或(和)眼底荧光血管造影(FFA)检查,并对二者的造影表现特点和差异进行比较.结果 FFA检查29只眼,诊断典型性CNV11只眼(37.93%),表现为黄斑部早期有网状强荧光性CNV,后期荧光素不断渗漏,并积存在RPE脱离范围之内.晚期形成明显区域性强荧光.诊断隐匿性CNV18只眼(62.07%),表现为早期无CNV特征,晚期有不明原因的边界不清强荧光5只眼(17.24%),而表现早期有边界模糊强荧光呈进行性渗漏,晚期强荧光区明显扩大13只眼(44.82%).ICGA检查32只眼,诊断典型性CNV32只眼(100%),表现为早期有强荧光性CNV性11只眼(34.37%),中期出现强荧光性CNV15只眼(46.88%),晚期又出现新的强荧光性CNV6只眼(18.75%).表明FFA和ICGA在渗出型AMD的CNV的诊断比率上,二者有显著差异.ICGA比FFA能更精确地显示黄斑部的CNV,而对于黄斑部视网膜下出血、浆液性色素上皮脱离等视网膜病变则不如FFA显示明确.结论 ICGA能发现FFA不能发现的CNV,在显示CNV的数量、位置、范围等方面比FFA敏感和准确,是诊断渗出型AMD的CNV和指导其激光光凝的一项重要工具.     

光动力疗法治疗渗出性年龄相关性黄斑变性

目的观察光动力疗法(photodynamic therapy,PDT)治疗渗出性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效。方法回顾分析经荧光素眼底血管造影(fundus fluorescein angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)以及光学相干断层扫描(optical coherence tomography,OCT)检查确诊的21例(31眼)渗出性AMD患者PDT治疗前及治疗后的临床资料,主要以视力、FFA及(或)ICGA、OCT的改变为观察指标,评价PDT对渗出性AMD的治疗效果。结果治疗后13眼视力明显改善(视力提高≥2行),占41.9%;14眼视力稳定不变(视力波动在1行以内),占45.2%;4眼视力下降2行,占12.9%。大部分患眼于PDT治疗后眼底出血和渗出减轻;ICGA检查显示:PDT治疗后1周,16眼CNV的渗漏明显减少或完全停止,8眼渗漏完全停止。OCT检查显示:CNV周围视网膜脉络膜水肿以及神经上皮脱离好转。5例6眼患者在PDT治疗过程中及治疗后发生视网膜神经上皮脱离范围变大,1例1眼发生黄斑部再次大面积出血,所有病例均未发生任何全身不良反应。结论单次和重复PDT治疗可以部分或完全封闭渗出性AMD的CNV,PDT治疗对病灶周围的正常视网膜和脉络膜组织短期内有轻度影响,对视力无损害。     

特发性水螅状脉络膜血管病变的临床分析

目的：探讨特发性水螅状脉络膜血管病变（idiopathic polypoidal choroidal vasculopathy,IPCV)的临床特征。方法：回顾分析161例（202只眼）在1995年11月－2001年4月期间诊断为湿性型老年黄斑变性（age-related macular degeneration,AMD)患者的临床资料，并对其荧光素眼底血管造影（fundus fluorescein angiography,FFA）和吲哚青绿血管造影（indocyanine green angiography,ICGA)进行了重新分析。结果：14例（8．7％）17只眼原诊断为湿性型AMD的患者重新诊断为IPCV。国人IPCV多发生于男性（78．6％），且单眼受累状主（78．6％）。发病年龄48－78岁，平均61．5岁。ICGA显示IPCV病变呈一异常分支的脉络膜血管网，血管网的末梢有水螅状扩张、膨隆；病变位于黄斑区及颞上、下血管弓周围者12只眼（70．6％），视乳头旁5只眼（29．4％）。结论：IPCV易误诊为湿性型AMD，但其ICGA显示的分支状脉络膜血管网及末梢的水螅状血管扩张有助于两者的诊断与鉴别 诊断。     

萎缩型老年性黄斑变性的吲哚青绿和荧光素眼底血管造影观察

目的 观察和评价萎缩型老年性黄斑变性(age-related macular degeneratioin, AMD)的荧光素眼底血管造影(fundus fluoresce in angiography, FFA)与吲哚青绿血管造影(indocyanine green angiography, ICGA)图像特征和对比检查的应用价值。 方法 回顾分析73例萎缩型AMD患者95只眼的彩色眼底照相、FFA和ICGA检查资料，其中包括视网膜色素上皮(retinal pigment epithelium, RPE)色素脱失与萎缩19例26只眼、玻璃疣15例30只眼和39例单侧渗出性AMD患者的对侧眼39只。 结果 26只RPE色素脱失与萎缩的眼中，24只色素脱失眼 FFA表现为晚期斑片状强荧光，ICGA表现为斑片状强弱相间荧光；地图状萎缩2只眼，FFA表现为斑片状强荧光，ICGA表现为边界清晰的弱荧光内见脉络膜毛细血管缺损，仅有脉络膜大血管。8只硬性玻璃疣眼FFA表现为强荧光，ICGA表现为持续斑点状 强荧光；16只软性玻璃疣眼FFA表现为强荧光，ICGA表现为持续性斑片状强弱相间荧光；6只同时有软性和硬性玻璃疣眼FFA表现为强荧光，ICGA表现为斑点状强弱相间荧光。当玻璃疣ICGA表现为弱荧光时，FFA所见到的玻璃疣的数量及范围较ICGA 所见者更多更大；当玻璃疣ICGA表现为强荧光时，FFA检查所见到的玻璃疣的数量及范围较ICGA所见更少。单侧渗出型AMD对侧39只眼中，ICGA检查发现32只眼、FFA检查发现31只眼有玻璃疣及RPE色素脱失与萎缩的异常荧光。 结论 ICGA与FFA同步检查为观察萎缩型AMD的眼底图像特征提供了完善的检查手段。 （中华眼底病杂志，2003，19：79-82）     

息肉状脉络膜血管病变与老年黄斑变性对比分析

目的探讨息肉状脉络膜血管病变(PCV)与湿性老年黄斑变性(AMD)临床特征的区别与联系,以指导临床。方法回顾分析已确诊的PCV及湿性AMD的眼底彩照,荧光素血管造影(FFA),吲哚青绿血管造影(ICGA),光学相干断层扫描(OCT)结果及临床资料。结果PCV15例,年龄48-70岁,平均62.3岁;湿性AMD38例,年龄50-80岁,平均65.8岁。PCV患者眼底视网膜出血、脂质渗出、桔红色结节样病灶分别为11只眼(73.3%)、6只眼(40%)、4只眼(26.7%);AMD患者45只眼中视网膜出血、脂质渗出、青灰色病灶、瘢痕形成分别为25只眼(55.6%)、18只眼(40.0%)、20只眼(44.4%)、3只眼(6.77%)。FFA显示PCV患眼脉络膜息肉状结构、出血性色素上皮脱离(PED)、浆液性PED分别为1只眼(6.7%)、7只眼(46.7%)、2只眼(13.3%),ICGA均可见息肉状扩张病灶(100%);FFA显示AMD患眼典型脉络膜新生血管(CNV)、PED分别为5只眼(11.1%)、14只眼(31.1%),ICGA显示CNV23只眼(51.1%),均未见息肉状结构。PCV的OCT表现为视网膜色素上皮及脉络膜内层呈穹窿状向视网膜神经上皮隆起,其下见结节状改变;AMD则显示视网膜色素上皮和脉络膜毛细血管层呈局部梭形或不规则强反射带。结论PCV与湿性AMD不尽相同,可能是AMD的另一种特殊类型,治疗可能应有所不同,有待于进一步研究。     

Clinical characteristics of exudative age-related macular degeneration in Japanese patients

PURPOSE: To clarify the clinical characteristics of exudative age-related macular degeneration (AMD) in Japanese patients. DESIGN: Retrospective, observational, consecutive case series. METHODS: Two hundred and eighty-nine patients with neovascular AMD were examined. RESULTS: The authors classified the patients into three subtypes of neovascular AMD: polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. One hundred and fifty-eight patients (54.7%) were diagnosed with PCV and 102 patients (35.3%) with typical AMD. RAP was observed in 13 patients (4.5%). In 16 patients (5.5%), one eye had PCV and the other eye had typical AMD. Most patients with PCV and typical AMD had unilateral disease (81.6% and 94.1%, respectively) with a male preponderance (77.8% and 71.6%, respectively). Nine of 13 patients with RAP were female (69.2%). Patients with RAP were older (mean, 80.3 years for men and 75.3 years for women) than patients with other subtypes. Serous and hemorrhagic pigment epithelial detachment developed in 69 patients (43.7%) with PCV, 22 patients (21.6%) with typical AMD, and nine patients (69.2%) with RAP. In the patients with unilateral disease in each subtype, large drusen in the unaffected eye were seen in 24.0% with PCV, 30.2% with typical AMD, and 77.8% with RAP. CONCLUSIONS: Neovascular AMD in Japanese patients has different demographic features compared with that in White patients. In Japanese patients, there is a preponderance of PCV, male gender, unilaterality, and absence of drusen in the second eye, with the exception of RAP.     

眼底血管造影和OCT结合对CEC脉络膜新生血管分型的评估

目的应用荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）和光学相干断层扫描（OCT）3种影像检查评估中心性渗出性脉络膜视网膜病变（CEC）脉络膜新生血管（CNV）的分型和性质。方法采用FFA、ICGA和Strastus-TM型OCT仪3种检查观察并相互印证53例（56眼）CEC患者的CNV的形态及类型。结果FFA图像显示,典型性CNV25眼（44.64%）,部分典型性CNV11眼（19.64%）;隐匿性CNV2眼（3.57%）,其中纤维血管性色素上皮脱离型（F-PED）1眼,晚期无源性渗漏1眼,CNV瘢痕化13眼（23.21%）。ICGA图像显示,19眼（33.93%）在ICGA与FFA早期同时显示CNV,7眼（12.5%）FFA为非典型性CNV,ICGA表现为焦点状或边界清晰的斑状,1眼ICGA早期显示病灶周围及后极部伴有限局性脉络膜血管扩张,10眼（17.85%）在ICGA晚期显示弱荧光环;CNV瘢痕化9眼（16.07%）。OCT显示,21眼（37.5%）CNV呈类圆形团块位于视网膜神经上皮下间隙;22眼（39.29%）的CNV呈纺锤形或不规则形位于色素上皮层平面;1眼（4.76%）为不规则、松散、边界不清的中等或高光反射组织;9眼（19.64%）色素上皮完整、连续,其下中等强度反射,局部视网膜隆起或不隆起。33眼伴有浆液性神经上皮脱离;2眼伴有出血性色素上皮脱离。结论采用眼底血管造影和OCT相结合评判CNV的状况可以明确病情,提供治疗的依据。     

High resolution Fourier-domain optical coherence tomography of retinal angiomatous proliferation

PURPOSE: To study the anatomic details of retinal angiomatous proliferation (RAP) in patients with age-related macular degeneration (AMD) using high-resolution Fourier-domain optical coherence tomography (Fd-OCT) and its three-dimensional reconstructions. METHODS: A Fd-OCT instrument was used to image five patients clinically diagnosed with RAP. A series of 100 raster-scanned B-scans centered over the macula was registered and rendered as a three-dimensional volume. These retinal structures were analyzed for anatomic details of the RAP lesions. RESULTS: The RAP lesion could be identified within the retina on Fd-OCT in all five cases. Fd-OCT images of the first four cases revealed areas of intraretinal neovascularization (IRN) in the deep retina adjacent to a pigment epithelial detachment (PED). There was neovascular proliferation anteriorly and posteriorly through a break in the retinal pigment epithelium (RPE). In three of the four cases, Bruch membrane remained intact. There was no identifiable choroidal neovascularization (CNV). The fifth case had both subretinal and sub-RPE neovascular membranes without a PED. CONCLUSION: Fd-OCT provides unprecedented in vivo detail of the anatomy of RAP lesions that nearly resembles histologic specimens. This study suggests that the initial neovascular process in RAP can originate either within the retina or in the sub-RPE space.     

引起黄斑出血的视网膜血管病变22例临床分析

目的 分析临床误诊的引起黄斑出血的视网膜血管病变，探讨血管造影技术在鉴别诊断中的意义。方法 对589例黄斑出血患者进行眼底荧光造影(FFA)及部分同时进行了吲哚青绿血管造影(ICGA)中22例诊断与造影前不符，分析误诊原因，评价不同血管造影技术在诊断与鉴别诊断中的作用。结果 22例黄斑出血病例中，误诊为湿性年龄相关性黄斑变性者13例，糖尿病性视网膜病变5例，中心性渗出性视网膜脉络膜炎3例，视网膜中央静脉阻塞1例。通过造影检查明确诊断为黄斑分支静脉阻塞者12例，视网膜大动脉瘤9例，遗传性视网膜血管扭曲1例，均属视网膜血管病变。结论 后极部视网膜血管病变所引起的出血可因累积黄斑而误诊，眼底荧光造影是鉴别出血原因的主要手段，而在出血较多无法发现原发病灶时，吲哚青绿血管造影可以作为有效的补充。     

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.