About OJO | Search | Ahead of print | Current Issue | Archives | Author Instructions | Reviewer Guidelines | Online submissionLogin 
Oman Journal of Ophthalmology Oman Journal of Ophthalmology
  Editorial Board | Subscribe | Advertise | Contact
https://www.omanophthalmicsociety.org/ Users Online: 367  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents    
LETTER TO THE EDITOR
Year : 2014  |  Volume : 7  |  Issue : 2  |  Page : 104-106  

Retinal pigment epithelial tear after intravitreal bevacizumab injection for exudative age-related macular degeneration


1 Vitreoretina Services, North Bengal Eye Centre, Siliguri, West Bengal, India
2 Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Web Publication19-Jul-2014

Correspondence Address:
Sunil Kumar Singh
Consultant Vitreoretinal Surgeon, North Bengal Eye Centre, Siliguri - 734 001, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.137178

Rights and Permissions

How to cite this article:
Singh SK, Deka S. Retinal pigment epithelial tear after intravitreal bevacizumab injection for exudative age-related macular degeneration. Oman J Ophthalmol 2014;7:104-6

How to cite this URL:
Singh SK, Deka S. Retinal pigment epithelial tear after intravitreal bevacizumab injection for exudative age-related macular degeneration. Oman J Ophthalmol [serial online] 2014 [cited 2020 Jan 18];7:104-6. Available from: http://www.ojoonline.org/text.asp?2014/7/2/104/137178

Sir,

Retinal pigment epithelial (RPE) tears have been reported as a result of exudative age-related macular degeneration (AMD) disease process itself as well as various treatment modalities including thermal laser, photodynamic therapy, and antivascular endothelial growth factor (anti-VEGF) therapy. [1] Bevacizumab (Avastin®; Genentech, South San Francisco, CA) is a recombinant humanized monoclonal antibody that binds all the biologically active isoforms of VEGF-A, inhibiting its interaction with receptors found on endothelial cells. It has been used increasingly as an off-label treatment for exudative AMD. [2],[3],[4] We narrate our experience in an elderly patient who developed RPE tear following the second injection of bevacizumab for occult choroidal neovascular membrane.

A 79-year-old nondiabetic and nonhypertensive female patient presented with sudden diminution of vision in her right eye of 1-week duration. The presenting visual acuity was counting fingers at one foot in the right eye and 20/30; N6 in the left eye. Fundus examination revealed submacular hemorrhage along with hard drusen in the right eye and hard drusen in the left eye [Figure 1]a. Fundus fluorescein angiography (FFA) showed blocked fluorescence due to submacular hemorrhage, multiple petechial hyperfluorescent lesions consistent with hard drusen, and a hyperfluorescent lesion in the bed of the submacular hemorrhage corresponding to occult choroidal neovascular membranein the right eye and tiny hyperfluorescent lesions consistent with macular hard drusen in the left eye [Figure 1]b. Optical coherence tomography (OCT) showed irregular RPE thickening and loss of foveal contour in the right eye and normal scan in the left eye [Figure 1]c.
Figure 1: (a) Color fundus photograph showing submacular hemorrhage along with hard drusen in the right eye and multiple hard drusen at the macula in the left eye, (b) Late-phase fundus fluorescein angiography (FFA) photograph of the right eye showing blocked fluorescence due to submacular hemorrhage, a hyperfluorescent lesion in the bed of the submacular hemorrhage corresponding to occult choroidal neovascular membrane, (c) Optical coherence tomography (OCT) photograph of the right eye showing irregular retinal pigment epithelial (RPE) thickening and loss of foveal contour in the right eye

Click here to view


Based on the above features (FFA and OCT correlation), a diagnosis of occult choroidal neovascular membrane was made in the right eye. The patient opted for intravitreal bevacizumab injection (1.25 mg in 0.1 mL).

She achieved 20/60; N24 in the right eye 4 weeks post bevacizumab intravitreal injection. Fundus examination of the right eye revealed clearing of submacular hemorrhage centrally [Figure 2]a. OCT of the right eye showed small neurosensory detachment [Figure 2]b. The patient underwent the second injection of intravitreal bevacizumab.
Figure 2: (a) Color fundus photograph of the right eye showing central clearing of submacular hemorrhage 4 weeks post bevacizumab injection, (b) Optical coherence tomography (OCT) photograph of the right eye showing small neurosensory detachment 4 weeks post bevacizumab injection

Click here to view


The patient returned 4 weeks later with diminution of vision in the right eye. Best-corrected visual acuity was 20/200; N36 in the right eye. Fundus examination revealed a crescentric area of denuded RPE involving the foveal region [Figure 3]a. FFA showed RPE tear with central blocking hypofluorescence and adjacent crescentric hyperfluorescence [Figure 3]b. OCT imaging of the macula displayed thickened hyper-reflective RPE layer with obvious tear and adjacent subretinal fluid [Figure 3]c.
Figure 3: (a) Color fundus photograph of the right eye revealing a crescentric area of denuded retinal pigment epithelial (RPE) involving foveal region 4 weeks after the second bevacizumab injection, (b) Late-phase fundus fluorescein angiography (FFA) photograph of the right eye showing retinal pigment epithelial (RPE) tear with central blocking hypofluorescence and adjacent crescentric hyperfluorescence after the second bevacizumab injection, (c) Optical coherence tomography (OCT) picture of the right eye displaying thickened hyper-reflective retinal pigment epithelial (RPE) layer with obvious tear and adjacent subretinal fluid

Click here to view


Shaikh et al. estimated the incidence of RPE tears following intravitreal bevacizumab therapy for choroidal neovascularization associated with AMD at 1.6%. [5] Anti-VEGF injections may contribute to RPE tears by causing loss of tight junction gene transcription resulting in decreased RPE intercellular adherence. Furthermore, anti-VEGF therapy leads to contraction of choroidal neovascular membranes.

Our case had occult choroidal neovascular membrane in the right eye. The patient developed RPE tear after the second intravitreal bevacizumab injection.

Ophthalmologists should be aware of the fact that RPE tears although rare, may occur after intravitreal bevacizumab therapy for choroidal neovascularization associated with AMD.

 
   References Top

1.Hoskin A, Bird AC, Sehmi K. Tears of detached retina pigment epithelium. Br J Ophthalmol 1981;65:417-22.  Back to cited text no. 1
[PUBMED]    
2.Gelisken F, Inhoffen W, Partsch M. Retinal pigment epithelial tear following after photodynamic therapy for choroidal neovascularization. Am J Ophthalmol 2001;131:518-20.  Back to cited text no. 2
    
3.Spandau UH, Jonas JB. Retinal pigment epithelium tear after intravitreal bevacizumab for exudative age-related macular degeneration. Am J Ophthalmol 2006;142:1068-70.  Back to cited text no. 3
    
4.Meyer CH, Mennel S, Schmidt JC, Kroll P. Acute retinal pigment epithelial tear following intravitreal bevacizumab (Avastin) injection for occult choroidal neovacularisation secondary to age related macular degeneration. Br J Ophthalmol 2006;90:1207-8.  Back to cited text no. 4
[PUBMED]    
5.Shaikh S, Olson JC, Richmond PP. Retinal pigment epithelial tears after intravitreal bevacizumab injection for exudative age-related macular degeneration. Indian J Ophthalmol 2007;55:470-2.  Back to cited text no. 5
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
   
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed1611    
    Printed18    
    Emailed0    
    PDF Downloaded172    
    Comments [Add]    

Recommend this journal