Mechanism of Retinal Pigment Epithelium Tear Formation Following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy Revealed by Spectral-Domain Optical Coherence Tomography
Mechanism of Retinal Pigment Epithelium Tear Formation Following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy Revealed by Spectral-Domain Optical Coherence Tomography
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DOI：
10.1016/j.ajo.2013.06.024
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发表时间：
2013-11-01
影响因子：
4.2
通讯作者：
Sarraf, David
中科院分区：
文献类型：
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作者：
Nagiel, Aaron;Freund, K. Bailey;Sarraf, David
目的：利用光谱域光学相干断层扫描（OCT）研究玻璃体内抗血管内皮生长因子（VEGF）治疗新生血管性年龄相关性黄斑变性（AMD）患者视网膜色素上皮（RPE）撕裂的机制。设计：回顾性观察性病例系列。方法：对新生血管性AMD患者给予玻璃体内抗vegf药物后发生RPE撕裂的8只眼的OCT图像进行评估。撕裂前和撕裂后的图像进行比较，以阐明在这种情况下RPE撕裂发生的机制。结果：在所有眼睛中，撕裂前图像显示血管化色素上皮脱离（PED）含有与脉络膜新生血管（CNV）一致的高反射物质。该CNV粘附于RPE下表面，并在RPE轮廓上形成可收缩褶皱。在6只眼睛中，收缩的新生血管组织跨越PED，导致Bruch膜向外弯曲，上覆RPE单层呈尖峰状。8只眼中有6只在第一次注射抗vegf后发生RPE撕裂。撕裂后OCT图像显示RPE不连续性，CNV附着在收缩的RPE上。在所有的眼睛中，RPE沿未与CNV或Bruch膜接触的裸RPE段破裂。结论：AMD继发血管化PEDs的眼睛可能显示出特定的OCT表现，这增加了玻璃体内注射抗vegf后RPE撕裂的风险。附着在RPE下表面的新生血管组织的快速内陷和收缩可能会产生巨大的收缩力，撕裂这个已经紧张的组织层。(C) 2013年Elsevier Inc.版权所有。)
PURPOSE: To demonstrate the mechanism by which retinal pigment epithelium (RPE) tears occur in eyes with neovascular age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) agents using spectral-domain optical coherence tomography (OCT).DESIGN: Retrospective observational case series.METHODS: OCT images of 8 eyes that developed RPE tears following the administration of intravitreal anti-VEGF agents for neovascular AMD were evaluated. Pretear and posttear images were compared in order to elucidate the mechanism by which RPE tears occur in this setting.RESULTS: In all eyes, pretear images revealed a vascularized pigment epithelial detachment (PED) containing hyperreflective material consistent with choroidal neovascularization (CNV). This CNV was adherent to the undersurface of the RPE and created contractile folds in the RPE contour. In 6 eyes, contractile neovascular tissue spanned the PED, causing outward bowing of the Bruch membrane and a peaked appearance to the overlying RPE monolayer. RPE tears occurred after the first anti-VEGF injection in 6 of 8 eyes. The posttear OCT images showed a discontinuity in the RPE with the CNV adherent to the retracted RPE. In all eyes, the RPE ruptured along a segment of bare RPE not in Contact with the CNV or Bruch membrane.CONCLUSIONS: Eyes with vascularized PEDs secondary to AMD may show specific OCT findings that increase the risk for RPE tear following intravitreal anti-VEGF injection. Rapid involution and contraction of neovascular tissue adherent to the undersurface of the RPE may impart a substantial contractile force that tears this already-strained tissue layer. ((C) 2013 by Elsevier Inc. All rights reserved.)