AMD Case 1 RPE tear

B1: RPE rupture. Choroidal vascularization can be seen in the area where there is no RPE and a dark area towards the nasal that corresponds to the coiled RPE.

C1: onset of fibrosis after 6 months of follow-up

D1: severe macular fibrosis with pigment deposition after 2 years of follow-up

B2 (blue AF): The area where there is no RPE is hypoAF while the coiled RPE is seen as a hyperAF zone.

C2 (green AF): appearance after 6 months of follow-up

D2 (green AF): appearance after 2 years of follow-up

A: DEP with fibrovascular and serous component

B3: RPE rupture with rolling towards the nasal

C3: onset of subretinal fibrosis after 6 months of follow-up

D3: severe subretinal fibrosis after 2 years of follow-up

Description

78-year-old woman with vision loss in left eye

MCVA OD 20/25 LE 20/100

Type 1 macular neovascularization. OCT shows a large PED with dual components, fibrovascular and serous, as well as perilesional subretinal fluid (A).

After 1 intravitreal injection of anti-VEGF, a tear of the RPE with rolling of the same towards the nasal is observed (B).

VA remains at 20/100 for a few months, but progression to subretinal fibrosis leaves poor hand movement VA after 6 months (C) and 2 years of follow-up (D).

Comments

RPE tears are a complication of fibrovascular PEDs after treatment with antiangiogenic agents (14-20% of cases), although they can occur spontaneously (10-12% in natural history studies of the disease). The main risk factors are a large linear diameter of the PED, a high height of the PED and a prolonged evolution time of the PED. To date, there is no preventive strategy for RPE tears and no antiangiogenic agent has shown a lower risk of causing them than others. The long-term functional prognosis is very poor.

Description

Comments

Indication