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Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence

  • Retinal Disorders
  • Published:
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Abstract

Background

To review vascularized-pigment epithelial detachment (V-PED) treatment visual outcome, and to assess acute retinal pigment epithelium (RPE) tear incidence.

Methods

One hundred and thirty-two eyes of 125 consecutive patients with age-related macular degeneration and V-PED were included. Ninety-four eyes (71.2%) were associated with choroidal new vessels (CNV), 38 (28.8%) with retinal angiomatous proliferation (RAP). Patients, treated over a 10-year period with the time-current therapy, received: verteporfin photodynamic therapy (PDT) (group 1, 38 eyes), combined intravitreal triamcinolone acetonide (IVTA) and PDT (group 2, 44 eyes) or intravitreal anti-VEGF injection (bevacizumab or ranibizumab) (group 3, 50 eyes).

Results

Mean follow-up was 20.5 months. At month 12, all eyes treated with PDT or with IVTA and PDT showed a mean significant severe visual decrease. Eyes with CNV lost −0.67 and −0.37 logMAR (p < 0.01 and p < 0.01 respectively), and eyes with RAP −0.55 and −0.31 logMAR (p < 0.01 and p = 0.01 respectively). RPE tear occurred in 14 eyes (36.8%) and in six eyes (13.6%) in groups 1 and 2 respectively. Eyes treated with anti-VEGF therapy showed slight mean visual acuity decrease at month 12. Those with CNV had a mean baseline best-corrected visual acuity (BCVA) of 0.36 ± 0.24 logMAR, final of 0.44 ± 0.30 logMAR (−0.08 logMAR, n.s.). In eyes with RAP, mean baseline BCVA was 0.58 ± 0.39 logMAR, final was 0.78 ± 0.47 logMAR (−0.20 logMAR, n.s.). RPE tear occurred in 14 eyes (36.8%). Patients with either V-PED with CNV or a better baseline BCVA showed greater risk of acute RPE tear (p = 0.01 and p = 0.003 respectively).

Conclusions

Effective treatment for vascularized PED is still lacking. Until now, only stabilization of the disease has been achieved using anti-VEGF therapy, but the risk of RPE tear can further hamper our expectations. Baseline characteristics are helpful for prognosis, but patients must be informed of the uncertain response. New therapeutic strategies are needed.

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References

  1. Yannuzzi LA, Hope-Ross M, Slakter JS, Guyer DR, Sorenson JA, Ho AC, Sperber DE, Freund KB, Orlock DA (1994) Analysis of vascularized pigment epithelial detachments using indocyanine green videoangiography. Retina 14:99–113

    Article  PubMed  CAS  Google Scholar 

  2. Zayit-Soudry S, Moroz I, Loewenstein A (2007) Retinal pigment epithelial detachment. Surv Ophthalmol 52:227–243

    Article  PubMed  Google Scholar 

  3. Cohen SY, Creuzot-Garcher C, Darmon J, Desmettre T, Korobelnik JF, Levrat F, Quentel G, Paliès S, Sanchez A, De Gendre AS, Schluep H, Weber M, Delcourt C (2007) Types of choroidal neovascularization in newly diagnosed exudative age-related macular degeneration. Br J Ophthalmol 91:1173–1176

    Article  PubMed  CAS  Google Scholar 

  4. Coscas G, Koenig F, Soubrane G (1990) The pretear characteristics of pigment epithelial detachments. A study of 40 eyes. Arch Ophthalmol 108:1687–1693

    Article  PubMed  CAS  Google Scholar 

  5. Wasmuth S (2010) Pathogenetic concepts for pigment epithelial detachment in exudative AMD. Ophthalmologe 107:1109–1114

    Article  PubMed  CAS  Google Scholar 

  6. Axer-Siegel R, Ehrlich R, Rosenblatt I, Kramer M, Priel E, Yassur Y, Weinberger D (2004) Photodynamic therapy for occult choroidal neovascularization with pigment epithelium detachment in age-related macular degeneration. Arch Ophthalmol 122:453–459

    Article  PubMed  Google Scholar 

  7. Axer-Siegel R, Ehrlich R, Avisar I, Kramer M, Rosenblatt I, Priel E, Weinberger D (2006) Combined photodynamic therapy and intravitreal triamcinolone acetonide injection for neovascular age-related macular degeneration with pigment epithelium detachment. Ophthalmic Surg Lasers Imaging 37:455–461

    PubMed  Google Scholar 

  8. Ritter M, Bolz M, Sacu S, Deak G, Kiss C, Pruente C, Schmidt-Erfurth UM (2010) Effect of intravitreal ranibizumab in avascular pigment epithelial detachment. Eye 24:962–968

    Article  PubMed  CAS  Google Scholar 

  9. Brancato R, Introini U, Bolognesi G, Pacelli G, Trabucchi G, Pece A (2000) ICGA-guided laser photocoagulation of occult choroidal neovascularization in age-related macular degeneration. Indocyanine green angiography. Retina 20:134–142

    Article  PubMed  CAS  Google Scholar 

  10. Pece A, Isola V, Vadalà M, Calori G (2007) Photodynamic therapy with verteporfin for choroidal neovascularization associated with retinal pigment epithelial detachment in age-related macular degeneration. Retina 27:342–348

    Article  PubMed  Google Scholar 

  11. Arias L (2010) Treatment of retinal pigment epithelial detachment with antiangiogenic therapy. Clin Ophthalmol 4:369–374

    Article  PubMed  Google Scholar 

  12. Wygnanski-Jaffe T, Desatnik H, Alhalel A, Goldstein M, Lowenstein A, Zolf R, Moisseiev J (2006) Angiography-guided photodynamic therapy for large pigment epithelial detachments in age-related macular degeneration. Ophthalmic Surg Lasers Imaging 37:358–363

    PubMed  Google Scholar 

  13. Ergun E, Maar N, Ansari-Shahrezaei S, Wimpissinger B, Krepler K, Wedrich A, Stur M (2006) Photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide in the treatment of neovascular age-related macular degeneration. Am J Ophthalmol 142:10–16

    Article  PubMed  CAS  Google Scholar 

  14. Boscia F, Furino C, Sborgia L, Reibaldi M, Sborgia C (2004) Photodynamic therapy for retinal angiomatous proliferations and pigment epithelium detachment. Am J Ophthalmol 138:1077–1079

    Article  PubMed  Google Scholar 

  15. Boscia F, Parodi MB, Furino C, Reibaldi M, Sborgia C (2006) Photodynamic therapy with verteporfin for retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 244:1224–1232

    Article  PubMed  CAS  Google Scholar 

  16. Saito M, Lida T, Nagayama D (2008) Photodynamic therapy with verteporfin for age-related macular degeneration or polypoidal choroidal vasculopathy: comparison of the presence of serous retinal pigment epithelial detachment. Br J Ophthalmol 92:1642–1647

    Article  PubMed  CAS  Google Scholar 

  17. Pece A, Introini U, Bottoni F, Brancato R (2001) Acute retinal pigment epithelial tear after photodynamic therapy. Retina 21:661–665

    Article  PubMed  CAS  Google Scholar 

  18. Gelisken F, Inhoffen W, Partsch M, Schneider U, Kreissig I (2001) Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. Am J Ophthalmol 131:518–520

    Article  PubMed  CAS  Google Scholar 

  19. Goldstein M, Heilweil G, Barak A, Loewenstein A (2005) Retinal pigment epithelial tear following photodynamic therapy for choroidal neovascularization secondary to AMD. Eye 19:1315–1324

    Article  PubMed  CAS  Google Scholar 

  20. Lommatzsch A, Heimes B, Gutfleisch M, Spital G, Zeimer M, Pauleikhoff D (2009) Serous pigment epithelial detachment in age-related macular degeneration: comparison of different treatments. Eye 23:2163–2168

    Article  PubMed  CAS  Google Scholar 

  21. Lai TY, Chan WM, Liu DT, Lam DS (2007) Ranibizumab for retinal angiomatous proliferation in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 245:1877–1880

    Article  PubMed  CAS  Google Scholar 

  22. Meyerle CB, Freund KB, Iturralde D, Spaide RF, Sorenson JA, Slakter JS, Klancnik JM Jr, Fisher YL, Cooney MJ, Yannuzzi LA (2007) Intravitreal bevacizumab (Avastin) for retinal angiomatous proliferation. Retina 27:451–457

    Article  PubMed  Google Scholar 

  23. Kook D, Wolf A, Neubauer AS, Haritoglou C, Priglinger SG, Kampik A, Ulbig MW (2008) Retinal pigment epithelial tears after intravitreal injection of bevacizumab for AMD. Frequency and progress. Ophthalmologe 105:158–164

    Article  PubMed  CAS  Google Scholar 

  24. Chiang A, Louis K, Chang LK, Yu F (2008) Predictors of anti-VEGF-associated retinal pigment epithelial tear using FA and OCT analysis. Retina 28:1265–1269

    Article  PubMed  Google Scholar 

  25. Chen E, Kaiser RS, Vander JF (2007) Intravitreal bevacizumab for refractory pigment epithelial detachment with occult choroidal neovascularization in age-related macular degeneration. Retina 27:445–450

    Article  PubMed  Google Scholar 

  26. Golbaz I, Ahlers C, Stock G, Schütze C, Schriefl S, Schlanitz F, Simader C, Prünte C, Schimdt-Erfurth U (2011) Quantification of the therapeutic response of intraretinal, subretinal and subpigmentepithelial compartments in exudative AMD during anti-VEGF therapy. Invest Ophthalmol Vis Sci 52:1599–1605

    Article  PubMed  CAS  Google Scholar 

  27. Arora S, McKibbin M (2011) One-year outcome after intravitreal ranibizumab for large, serous pigment epithelial detachment secondary to age-related macular degeneration. Eye 25:1034–1038

    Article  PubMed  CAS  Google Scholar 

  28. Ruppenstein M, Ach T, Hoh A, Dithmar S (2010) Effect of intravitreal bevacizumab on pigment epithelial detachment in occult choroidal neovascularization. Ophthalmologe 107:827–830

    Article  PubMed  CAS  Google Scholar 

  29. Nicolò M, Ghiglione D, Calabria G (2006) Retinal pigment epithelial tear following intravitreal injection of bevacizumab (Avastin). Eur J Ophthalnol 16:770–773

    Google Scholar 

  30. Chang LK, Sarraf D (2007) Tears of the retinal pigment epithelium. An old problem in a new era. Retina 27:523–534

    Article  PubMed  Google Scholar 

  31. Smith BT, Kraus CL, Apte RS (2009) Retina pigment epithelial tears in ranibizumab-treated eyes. Retina 29:335–339

    Article  PubMed  Google Scholar 

  32. Spandau VHM, Jonas JB (2006) Retinal pigment epithelial tear after intravitreal bevacizumab for exudative age-related macular degeneration. Am J Ophthalmol 142:1068–1070

    Article  PubMed  CAS  Google Scholar 

  33. Gass JD (1984) Retinal pigment epithelial rip during krypton red laser photocoagulation. Am J Ophthalmol 98:700–706

    PubMed  CAS  Google Scholar 

  34. Michels S, Aue A, Simader C, Geitzenauer W, Sacu S, Schmidt-Erfuth U (2006) Retinal pigment epithelium tears following verteporfin therapy combined with intravitreal triamcinolone. Am J Ophthalmol 141:396–398

    Article  PubMed  CAS  Google Scholar 

  35. Dhalla MS, Blinder KJ, Tewari A, Hariprasad SM, Apte RS (2006) Retinal pigment epithelial tear following intravitreal pegaptanib sodium. Am J Ophthalmol 141:752–754

    Article  PubMed  CAS  Google Scholar 

  36. Meyer CH, Toth CA (2001) Retinal pigment epithelial tear with vitreomacular traction: a novel pathogenic feature. Graefes Arch Clin Exp Ophthalmol 239:325–333

    Article  PubMed  CAS  Google Scholar 

  37. Leitritz M, Gelisken F, Inhoffen W, Voelker M, Ziemssen F (2008) Can the risk of retinal pigment epithelium tears after bevacizumab treatment be predicted? An optical coherence tomography study. Eye 22:1504–1507

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The Authors wish to thank Michael John of the Vita-Salute San Raffaele University for the English language editing of this manuscript.

Conflict of interest

Ugo Introini: none. Ana Torres Gimeno: none. Fabrizio Scotti: none. Marco Setaccioli: none. Silvia Giatsidis: none. Francesco Bandello: Novartis Pharmaceuticals Corporation; Allergan, Inc.; Alcon, Inc.; Bayer Schering Pharma; Farmila-THEA; Genentech, Inc.; Pfizer, Inc.; Bausch & Lomb.

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Authors and Affiliations

  1. Department of Ophthalmology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Ugo Introini, Ana Torres Gimeno, Fabrizio Scotti & Marco Setaccioli

  2. Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy

    Silvia Giatsidis & Francesco Bandello

Authors
  1. Ugo Introini
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  2. Ana Torres Gimeno
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  3. Fabrizio Scotti
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  4. Marco Setaccioli
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  5. Silvia Giatsidis
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  6. Francesco Bandello
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Corresponding author

Correspondence to Ugo Introini.

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The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data if requested.

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Introini, U., Torres Gimeno, A., Scotti, F. et al. Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence. Graefes Arch Clin Exp Ophthalmol 250, 1283–1292 (2012). https://doi.org/10.1007/s00417-012-1955-2

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  • DOI: https://doi.org/10.1007/s00417-012-1955-2

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