Retinal Pigment Epithelial Tear After Intravitreal Ranibizumab Treatment for Retinal Angiomatous Proliferation

PurposeTo evaluate the incidence and associated risk factors of retinal pigment epithelium (RPE) tears after intravitreal ranibizumab injection treatment for retinal angiomatous proliferation (RAP).DesignRetrospective, observational case series.MethodsNinety-eight treatment-naïve RAP eyes (86 patients) that received intravitreal ranibizumab injections were included. All patients were treated with an initial series of 3 monthly loading injections, followed by further injections as required. Baseline characteristics and features were evaluated as potential risk factors for RPE tearing. The visual and anatomic outcomes after treatment were evaluated at 12 months from baseline.ResultsRPE tears had developed in 8.2% (8) of the eyes by 12 months. Of these, all had pigment epithelium detachment (PED) at baseline, and the majority (7) had developed an RPE tear within 3 months. Multiple regression analysis showed that higher PED (odds ratio [OR] = 1.411, 95% confidence interval [CI] = 1.199-1.888, P = .011) and thinner choroid (OR = 0.815, 95% CI = 0.719-0.912, P = .023) were associated with a higher risk of RPE tearing. The mean best-corrected visual acuity of the patients with RPE tearing (0.56 ± 0.49 logarithm of the minimal angle of resolution [logMAR]) was significantly worse at 12 months than that of patients without RPE tearing (0.74 ± 0.55 logMAR, P = .009) after treatment.ConclusionsRPE tears developed in 8.2% of eyes with RAP during the 12 months following ranibizumab injections. Higher PED height and thinner subfoveal choroidal thickness were associated with the development of RPE tears after ranibizumab treatment for RAP.