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| LETTER TO THE EDITOR |
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| Year : 2014 | Volume
: 7
| Issue : 2 | Page : 104-106 |
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Retinal pigment epithelial tear after intravitreal bevacizumab injection for exudative age-related macular degeneration
Sunil Kumar Singh1, Satyen Deka2
1 Vitreoretina Services, North Bengal Eye Centre, Siliguri, West Bengal, India
2 Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| Date of Web Publication | 19-Jul-2014 |
Correspondence Address:
Sunil Kumar Singh
Consultant Vitreoretinal Surgeon, North Bengal Eye Centre, Siliguri - 734 001, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-620X.137178
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 2023 Mar 30];7:104-6. Available from: https://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
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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
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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
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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 | |  |
| 1. | Hoskin A, Bird AC, Sehmi K. Tears of detached retina pigment epithelium. Br J Ophthalmol 1981;65:417-22. 
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| 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.
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| 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.
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| 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.
[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.
[PUBMED]  |
[Figure 1], [Figure 2], [Figure 3]
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