Double RPE Tears Analysis

Double RPE tears developed after intravitreal injection of anti-VEGF agents in 10 out of 11 eyes, and spontaneously (first tear developing without any previous treatment) in 1 eye. BCVA and CMT did not show significant change after the occurrence of RPE tears. In most cases, tears graded according to Sarraf et al. (12) remained stable over time. Gutfleish et al. (13) studied 37 RPE tears and found that BCVA deteriorated after RPE tear and during follow-up significantly, with 53.2% of eyes progressing to legal blindness at 12 months. More recently, Durkin et al. (14) noted a significant loss of one or more lines of vision from baseline, in 14 eyes with RPE tears, without association with the size of the tear. It is remarkable that improvement …show more content…
(12) classification, the RPE tear prognosis correlates with the greatest linear diameter of the rip and its involvement of the fovea. In our study, grading remained stable, with the majority of eyes presenting with a grade 3 RPE tear. Only 2 eyes harbored foveal-involving grade 4 tears in our study (Table 2), which may explain the relatively good visual prognosis. Even though a second tear developed in 6 eyes in our study, only one of these eyes progressed to a grade 4 tear and vision stability was the rule. We believe that one explanation for the lack of progression after the development of the initial rip may be related to the fact that significant forces on the RPE are released with the initial …show more content…
(6) proposed a model to describe RPE tear formation. Contraction of the type 1 neovascular complex induces tensile forces increased by anti-VEGF therapy leading to an RPE tear. This is exacerbated by the presence of a large PED (greater than 500 to 600 u in height) due to high hydrostatic pressure. Tears occur at the RPE junction of attached and detached RPE where the tangential force is greatest.. We hypothesize that double RPE tears, typically occur on two opposite sides of a vascularized PED, due to contractile forces by a CNV adherent to the posterior surface of the detached RPE, and spanning the entire PED area with variable orientation. In our cases, the CNV spanning the PED may induce tensile forces on each side of the PED. As weakness zones are located at the attached–detached RPE junction, the occurrence of first tear does not cancel tensile forces on the opposite side of the PED, and thus the second tear occurs due to fibrovascular contraction induced by anti VEGF treatment (Figure