Retinal Pigment Epithelial Tear Following Intravitreal Pegaptanib Sodium

doi:10.1016/j.ajo.2005.10.053

American Journal of Ophthalmology

Volume 141, Issue 4, April 2006, Pages 752-754

https://doi.org/10.1016/j.ajo.2005.10.053 Get rights and content

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.

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Cited by (89)

Bilateral giant retinal pigment epithelial tears in hypertensive choroidopathy
2019, American Journal of Ophthalmology Case Reports
Citation Excerpt :
Hoskin et al.11 first reported RPE tears. They generally are complications associated with choroidal neovascularization in AMD, and tears can occur after laser photocoagulation, photodynamic therapy, and intravitreal injections of antivascular endothelial growth factor drugs.12–16 However, the precise mechanism has not been clarified.
To report a case of hypertensive choroidopathy with bilateral bullous serous retinal detachments (SRDs), retinal pigment epithelial detachments (PEDs), and giant retinal pigment epithelial (RPE) tears.
A 68-year-old man with a history of hypertension and diabetes mellitus presented with bilateral visual loss of about 10 day's duration. He discontinued his oral medications for 2 months without the advice of a physician. At his first visit, the best-corrected visual acuities (BCVAs) were 0.02 in the right eye and 0.3 in the left eye (decimal notation), and the respective intraocular pressures were 15 and 13 mmHg. Bullous SRDs, large PEDs, and giant RPE tears were present bilaterally. Blot retinal hemorrhages and hard exudates were seen in the left eye. The systemic blood pressure was 231/77 mmHg, and bilateral lower leg edema was observed. Biochemical blood tests showed deteriorated renal function, hypoalbuminemia, and hyperglycemia. Ultra-wide-field fundus fluorescein angiography showed leakage at the areas of the SRDs and hyperfluorescent areas corresponding to the RPE tears bilaterally. Indocyanine green angiography showed hypofluorescent areas corresponding to the PEDs. Systemic computed tomography and magnetic resonance imaging were performed, and no malignancy was found. Based on these findings, hypertensive choroidopathy was diagnosed. A week after antihypertensive treatment, the SRDs and PEDs resolved bilaterally, and the BCVAs improved to 0.4 and 0.5 in the right and left eyes, respectively. The RPE tears remained in both eyes, although the SRDs and PEDs did not recur.
Hypertensive choroidopathy must be considered in the differential diagnosis of SRDs and/or PEDs.
Retinal pigment epithelial tears
2019, Journal Francais d'Ophtalmologie
A retinal pigment epithelial (RPE) tear is a well-known complication of retinal pigment epithelial detachments (PED) and may cause a significant visual impairment. The most common cause is a vascularized PED in patients with exudative age-related macular degeneration (AMD). The development of diagnostic imaging techniques brings us closer to the etiology and pathophysiological mechanisms of this entity, offering us new strategies for treatment and follow-up. The advent of intravitreal antiangiogenic treatment (anti-VEGF) has led to an increase in the number of reported cases of RPE tears, which are an important vision-limiting factor during treatment. However, RPE tears may occur spontaneously or as a consequence of thermal laser treatment, photodynamic therapy or anti-VEGF therapy. It is accepted that the mechanism of RPE tears is multifactorial. The optimization of the functional outcome of this complication has been described with continuous treatment with antiangiogenic drugs. The goal of the present review is to evaluate the incidence, risk factors and treatment of RPE tears.
Une déchirure de l’épithélium pigmentaire rétinien (EPR) est une complication bien connue des décollements épithéliaux pigmentaires rétiniens (DEP) et peut entraîner une déficience visuelle importante. La cause la plus fréquente est un DEP rétinien vascularisé chez des patients atteints de dégénérescence maculaire exsudative liée à l’âge. Le développement des techniques d’imagerie diagnostique nous rapproche de l’étiologie et des mécanismes physiopathologiques de cette entité, en nous proposant de nouvelles stratégies thérapeutiques et de suivi. L’avènement du traitement anti-angiogénique intra vitréen (anti-VEGF) a conduit à une augmentation du nombre de cas déclarés de déchirures EPR et constitue un facteur limitant important de la vision pendant le traitement. Cependant, les déchirures de EPR peuvent survenir spontanément ou par suite d’un traitement au laser thermique, d’une thérapie photodynamique ou d’une thérapie anti-VEGF. Il est admis que le mécanisme des déchirures EPR est multifactoriel. L’optimisation du résultat fonctionnel de cette complication a été décrite avec un traitement continu avec des médicaments anti-angiogéniques. L’objectif de la présente revue est d’évaluer l’incidence, les facteurs de risque et le traitement des déchirures de l'EPR.
Giant retinal pigment epithelial tear associated with fluid overload due to end-stage diabetic kidney disease
2017, American Journal of Ophthalmology Case Reports
Citation Excerpt :
Since Hoskin and associates1 first reported retinal pigment epithelial (RPE) tears, accumulated evidence has suggested that RPE tears could occur in the following situations: spontaneously,2 after treatment of choroidal neovascularization (CNV) and age-related macular degeneration (AMD)-associated pigment epithelial detachments by laser photocoagulation,2,3 or after intravitreal drug injections of vascular endothelial growth factor (VEGF) inhibitors.4
To report a case of a giant retinal pigment epithelial (RPE) tear associated with fluid overload in a patient with diabetic macular edema (DME) and kidney disease.
A 60-year-old man with type 2 diabetes mellitus and end-stage diabetic kidney disease who had gained weight because of fluid overload complained of a visual disturbance in the left eye that had started a few days earlier. The left fundus showed a RPE defect in two temporal quadrants under an extensive serous retinal detachment (SRD) with exacerbation of the original DME. Seven days later, he was admitted for severe edema and pleural effusion. No overt signs of congestive heart failure were noted. On admission, the RPE defect had markedly widened to involve the macula. Spectral-domain optical coherence tomography images showed substantial intraretinal fluid and an extensive SRD with rolled edges of the retinal pigment epithelium, which led to the diagnosis of a RPE tear. The fluid under the SRD was absorbed on the fourth hospital day and the substantial intraretinal fluid resolved on the eleventh day after systemic management of fluid overload only without ophthalmic treatment. The change in the appearance of the RPE area was minimal and the visual field defect remained even after 6 months.
A RPE tear may develop in association with fluid overload in patients with diabetes.
Part 7 - Drug-induced ocular side effects
2014, Drug-Induced Ocular Side Effects: Clinical Ocular Toxicology
Anti-VEGF response in macular hemorrhage and incidence of retinal pigment epithelial tears
2013, Canadian Journal of Ophthalmology
To study the visual and anatomic outcomes of serial anti–vascular endothelial growth factor (anti-VEGF) therapy for severe macular hemorrhage in eyes with exudative age-related macular degeneration (AMD).
Consecutive retrospective analysis.
Twenty eyes from 20 patients with severe macular hemorrhage (greater than 50% blockage with formal fluorescein angiography [FA]) secondary to wet AMD were studied.
We performed a chart review of patients at a single centre from May 2006 to September 2009. Presenting visual acuity and diameter of hemorrhage were recorded as well as number of injections, time by which no hemorrhage was remaining, and final anatomic outcome. Cardiovascular risk factors and use of antiplatelet medication or anticoagulation were noted.
Average presenting visual acuity was 1.55 (20/710), and number of injections needed for resolution of hemorrhage was 4. Visual acuity significantly improved from 1.55 (20/710) to 0.70 (20/100) after injections. Thirty-five percent of eyes were found to have an associated retinal pigment epithelial (RPE) tear, and these eyes were found to have received more injections. Final visual acuity was not significantly different in eyes with RPE tears compared with nontear eyes. Eighty-one percent of patients had associated cardiovascular risk factors; antiplatelet therapy and anticoagulation were not found to play a role in hemorrhage size.
RPE tears are found in a significant number of individuals with large macular hemorrhages secondary to exudative macular degeneration, but with continued treatment with anti-VEGF therapy, visual acuity can significantly improve even in the presence of these tears. Eyes with severe macular hemorrhage thus should be considered candidates for anti-VEGF therapy.
Étude des résultats visuels et anatomiques d'une série de thérapies anti-FCVE (facteur de croissance vasculaire endothéliale) dans les yeux ayant une dégénérescence maculaire liée à l'âge (DMA) exsudative avec hémorrhagies maculaires sévères.
Analyse rétrospective consécutive.
Vingt yeux de 20 patients ayant une grave hémorragie maculaire (plus de 50 % de blocage avec angiographie à la fluorescéine formelle) secondaire à une DMLA humide.
Nous avons examiné les dossiers des patients d'un seul centre, des mois de mai 2006 à septembre 2009. Nous avons retenu l'acuité visuelle et le diamètre de l'hémorragie à la présentation initiale, ainsi que le nombre d'injections, le moment où il ne restait plus d'hémorragie et le résultat anatomique final. Les facteurs de risque cardiovasculaire et l'utilisation de médicaments antiplaquettaires ou anti coagulation ont été notés.
La moyenne d'acuité visuelle à la présentation était de 1,55 (20/710) et la moyenne du nombre d'injections nécessaires pour résoudre l'hémorragie était de 4. L'acuité visuelle s'est grandement améliorée passant de 1,55 (20/710) à 0,70 (20/100) après les injections. On a constaté que 35 % des yeux avaient une déchirure de l'épithélium rétinien pigmenté (ERP) et que ces yeux avaient reçu plus d'injections. L'acuité visuelle finale n'était pas significativement différente dans les yeux ayant des déchirures de l'ERP, comparativement aux yeux n'en ayant pas. 81 % des patients avaient des facteurs de risque cardiovasculaires associés; l'on n'a pas trouvé que la thérapie antiplaquettaire et anticoagulation influaient sur la taille de l'hémorragie.
Les déchirures de l'ERP sont présentes dans un grand nombre de personnes ayant d'importantes hémorragies maculaires secondaires à la dégénérescence maculaire exsudative, mais un traitement continu de thérapie anti-FCVE, l'acuité visuelle peut s'améliorer grandement même en présence de ces déchirures. Les yeux qui ont une sévère hémorragie maculaire devraient ainsi être considérés comme des candidats à la thérapie anti-FCVE.
Incidence of retinal pigment epithelial tears after intravitreal ranibizumab injection for neovascular age-related macular degeneration
2011, Ophthalmology
To explore the association between treatment for neovascular age-related macular degeneration (AMD) and incidence and timing of retinal pigment epithelium (RPE) tears in ranibizumab-treated patients versus control treatment.
Results from 3 phase III clinical trials (ANti-VEGF antibody for the treatment of predominantly classic CHORoidal neovascularization in age-related macular degeneration [ANCHOR], Minimally classic/occult trial of the Anti-VEGF antibody Ranibizumab In the treatment of Neovascular Age-related macular degeneration [MARINA], and A Phase IIIb, Multicenter, Randomized, Double-Masked, Sham Injection-Controlled Study of the Efficacy and Safety of Ranibizumab in Subjects with Subfoveal Choroidal Neovascularization [CNV] with or without Classic CNV Secondary to Age-Related Macular Degeneration [PIER]) were retrospectively reviewed to identify patients who developed RPE tears during the study period, detected on fluorescein angiography performed at prespecified intervals.
Patients with baseline and post-baseline angiographic assessments.
Patients received intravitreal ranibizumab (0.3 or 0.5 mg) or control treatment (verteporfin photodynamic therapy [PDT] in ANCHOR and sham intravitreal injections in ANCHOR, MARINA, and PIER).
Incidence and timing of RPE tears during the treatment period.
Data from 1298 patients were analyzed. No statistically significant differences in RPE tear incidence were observed. The pooled rate of RPE tears was 1.8% with 0.5 mg ranibizumab, 3.0% with 0.3 mg ranibizumab, and 1.6% in the control group. Most (76%; 16/21) RPE tears in ranibizumab-treated patients were identified within 3 months of initiating treatment, whereas the majority (80%; 4/5) of late-onset RPE tears occurred in control patients. In patients who developed RPE tears, better visual acuity (VA) outcomes were observed in those treated with ranibizumab versus control treatment.
As studied in these trials, no statistically significant differences in the incidence of RPE tears within a 2-year treatment period were observed in patients who received ranibizumab (0.5 or 0.3 mg) versus control treatment, although most RPE tears with ranibizumab occurred within 3 months of initiating treatment. Mean VA was better in patients who developed RPE tears while receiving ranibizumab than in those who received control treatment, suggesting a potential benefit of continued ranibizumab therapy in patients with neovascular AMD who developed RPE tears.
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Brief reportRetinal Pigment Epithelial Tear Following Intravitreal Pegaptanib Sodium

Purpose

Design

Methods

Results

Conclusions

Am J Ophthalmol

Pathogenesis of tears of the retinal pigment epithelium

Br J Ophthalmol

Retinal pigment epithelial tears through the fovea with preservation of good visual acuity

Arch Ophthalmol

Brief report
Retinal Pigment Epithelial Tear Following Intravitreal Pegaptanib Sodium