Centrifugal extension of retinal atrophy in retinal pigment epithelium tears secondary to age-related macula degeneration

Session Details

Session Title: Free Paper Session 22: AMD V

Session Date/Time: Sunday 10/09/2017 | 08:00-09:30

Paper Time: 08:48

Venue: Room 115

First Author: : V.Capuano FRANCE

Co Author(s): :    R. Farci   A. Miere   F. Amoroso   F. Bandello   E. Souied   G. Querques              

Abstract Details

Purpose:

To investigate the progression of retinal atrophy in patients with retinal pigment epithelial (RPE) tears secondary to neovascular age-related macular degeneration (AMD).

Setting:

Retrospective case series

Methods:

Patients were analysed at 2 high-volume referral centres: the University Eye Clinic, Hopital Intercommunal, Créteil (France) and the Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, (Italy). Included patients had a complete ophthalmological examination, including best-correct visual acuity (BCVA) quantification (Snellen) slight lamp examination and dilated fundus examination. Type and number of intravitreal treatments were also recorded and analysed. The extension of areas deprived of RPE was analysed on fundus autofluorescence (FAF) imaging by means of the Region Finder (Heidelberg Engineering, Heidelberg, Germany) yearly from baseline to last examination.

Results:

Sixteen eyes of 14 patients were included (12 females, mean age 85.1 ± 5.3 years). Mean follow up was 70.11±15.5 months. BCVA was~ 20/160 (0.91 ± 0.36 logMAR) and ~20/200 (0.98 ± 0.59 logMAR) at last visit (p = 0.909). Eight eyes showed a nasal RPE retraction, and 8 eyes showed a temporal RPE retraction. Five patients (7 eyes) diagnosed with RPE tear were treatment-naive at presentation. In 9 patients (9 eyes) previously diagnosed with vascularized pigment epithelial detachment, RPE tears developed 8.7± 11.2months (range 3-37 months) after the first examination. RPE tear developed after a mean of 2.95 ± 2.8 intravitreal injections (range 1-7) (Ranibizumab, Lucentis®, Novartis, Basel, Switzerland) in all cases. After the occurrence of RPE tear, a mean of 12 ± 11.4 (range 3-42 months) intravitreal injections were administrated. The average area of atrophy was 6.89±5.4mm2 at baseline and of 9.21±7.7 mm2 at the last visit (p<0.0001). This accounts for a progression of 0.36±0.46 mm2/year. In all cases, FAF showed a centrifugal extension of retinal atrophy.

Conclusions:

In our series, area of retinal atrophy enlarged over time. A centrifugal extension from the area of outer hyperautofluorescence, bordering the exposed area of Bruch’s membrane was observed. The progression of the atrophy does not seem to impact the visual prognosis in eyes undergoing repeated anti-VEGF treatments.

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