Patients undergoing PDT for age-related macular degeneration who were treated with PDT to induce RPE were subjected to comprehensive ophthalmological examination, fluorescein angiography and OCT at baseline (V0), 3, 6-9 months after treatment and at 12 months post treatment using ETDRS charts to measure visual acuity; thickness measurements included intraretinal, extrafoveal Choriocapillaris RPE complex thickness as well as total foveal thickness by OCT.

Risk Factors

Retinal Pig Epithelium Tears (RPET) are an increasingly prevalent complication of RPE detachment associated with wet age-related macular degeneration, often leading to significant visual loss and necessitating ongoing anti-vascular endothelial growth factor therapy (anti-VEGF). In this article, the author presents current knowledge regarding its epidemiology and etiology; current diagnostic tools available; impactful treatment outcomes discussed as well as an approach that balances visual outcomes with therapeutic tolerability; ultimately an anti-VEGF approach that strikes an optimal balance between visual outcome and therapeutic tolerability is proposed for optimal treatment outcomes and clinical tolerability is described herein.

Diagnosis

Retinal pigment epithelium tears (RPETs) can be an adverse and reversible side effect in patients taking anti-vascular endothelial growth factor (anti-VEGF) medications to treat neovascular age-related macular degeneration. When present, an RPET indicates that the integrity of the retinal pigment epithelium monolayer has been compromised and can be detected using spectral domain optical coherence tomography.

This open cohort study’s purpose was to evaluate the incidence and association between RPET and best-corrected visual acuity outcomes among patients receiving photodynamic therapy for neovascular AMD. Patients underwent complete ophthalmologic examination, angiofluoresceinography, spectral domain optical coherence tomography before treatment as well as at 3, 6, 9 and 12 months after.

Treatment

Anti-VEGF therapy has become the preferred approach to treating RPET. Drugs such as ranibizumab, aflibercept or bevacizumab have shown to significantly decrease incidence and improve functional outcome when compared with sham controls.

Not all patients respond favorably to anti-VEGF therapy; unfortunately, some sufferers experience severe adverse reactions called macular edema that leads to poor visual outcomes. Here, we will address both its causes and management following A-VEGF treatment as well as potential therapies that could provide relief.

RPET is an irreversible yet treatable complication of macular degeneration, typically brought on by the formation of vascular deposits in the retinal pigment epithelium (RPE), leading to swelling of the retina and consequent vision loss. Treatment options to manage or slow the progression of RPET include regular monitoring and compliance with anti-VEGF therapy. Additionally, combination therapies may enhance the efficacy of anti-VEGF therapy in terms of lowering RPET rates and improving functional outcomes. Studies have demonstrated that combining photodynamic therapy (TDT) and IVV A-VEGF can significantly decrease RPET incidence rates in clinical settings. Furthermore, this combination also serves to decrease both duration and intensity of recurrent edema episodes; ultimately improving quality of life for those suffering from macular degeneration with RPET.