Pigment epithelial tears associated with anti-VEGF therapy: incidence, long-term visual outcome, and relationship with pigment epithelial detachment in age-related macular degeneration.

PURPOSE To evaluate the prevalence of retinal pigment epithelium (RPE) tears associated with anti-VEGF therapy and its relation with retinal pigment epithelial detachment (PED). METHODS A total of 226 patients with exudative age-related macular degeneration treated with intravitreal anti-VEGF were included retrospectively in the study. The presence of RPE tears; the effect of the presence, height, and duration of PED on the rate of RPE tears; and change in visual acuity during follow-up were recorded. RESULTS Among 226 study patients, 28 (12.3%) had RPE tears. The RPE tear rate was significantly higher in patients with vascularized PED (vPED) than in those without PED (19.7% vs. 2.1%; P < 0.001). The change in visual acuity after the formation of RPE tear was not statistically significant (on logMAR scale: 0.92 ± 0.49 initially, 0.89 ± 0.41 after the RPE tear, 0.96 ± 0.45 at the last follow-up; P = 0.613). Pigment epithelial detachment height >580 μm (odds ratio = 69.4; 95% confidence interval = 16.7-288.1) and PED duration ≤ 4.5 months (odds ratio = 166.7; 95% confidence interval = 15.2-1000) were found to be significant risk factors for RPE tear formation. CONCLUSION The RPE tears are not infrequent among eyes treated with intravitreal anti-VEGFs. The presence, increased height, and shorter duration of vPED are potential risk factors for RPE tears associated with anti-VEGF therapy.