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THE OCCURRENCE, CHARACTERISTICS, MANAGEMENT, AND PROGNOSIS OF RETINAL PIGMENT EPITHELIUM TEARS IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY

A Retrospective Study of 397 Patients

Zhao, Xin-yu, MD*; Xia, Song, MD*,†; Luo, Ming-yue, MD*; Wang, Er-qian, MD*; Chen, You-xin, MD, PhD*

doi: 10.1097/IAE.0000000000002389
Original Study: PDF Only

Purpose: To investigate retinal pigment epithelium (RPE) tears in patients with polypoidal choroidal vasculopathy.

Method: A retrospective review of polypoidal choroidal vasculopathy cases with confirmed RPE tears was conducted. Patients' comprehensive clinical data were collected and analyzed. The treatment strategy was a loading dose of one intravitreal antivascular endothelial growth factor injection, combined with additional injections if exudative activities or visual deterioration were detected.

Results: Among 397 polypoidal choroidal vasculopathy patients, 33 patients with RPE tears (8.3%) were included. 42.4% of them happened spontaneously. Pigment epithelial detachment (PED) occurred more frequently in RPE tear patients and most of them had serous vascularized or hemorrhagic PED. The height and greatest linear diameter of PED, and the subfoveal choroidal thickness of these cases were significantly larger, whereas the central foveal thickness was significantly smaller. Most of the RPE tears occurred at the edge of the PED. After our treatment strategy, patients' best-corrected visual acuity improved significantly from 2.13 ± 1.24 (median 20/52) to 1.32 ± 1.31 (median 20/166). Large subretinal hemorrhage may increase the risk of the formation of subretinal fibrosis (P < 0.05).

Conclusion: Retinal pigment epithelium tears in polypoidal choroidal vasculopathy are associated with high subRPE hydrostatic pressure, produced by a large PED or hemorrhage. After our intervention strategy, this condition may not necessarily result in poor prognosis.

This is one of the largest case series when investigating the occurrence, characteristics, management, and prognosis of retinal pigment epithelium tears in patients with polypoidal choroidal vasculopathy; most of these cases had larger serous vascularized or hemorrhagic pigment epithelial detachment, and the subfoveal choroidal thickness was also thicker. Our intervention strategy was relatively comprehensive with acceptable prognosis.

*Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and

Department of Ophthalmology, Guizhou Provincial People's Hospital, Guizhou, China.

Reprint requests: You-xin Chen, MD, PhD, Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; e-mail: 478252553@qq.com

None of the authors has any financial/conflicting interests to disclose.

X. -y. Zhao and S. Xia authors contributed equally to this study.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent was obtained from all individual participants included in the study.

X. -y. Zhao conducted the entire procedure including the collection of medical records, image evaluation, statistical analysis, drafting the manuscript, and manuscript revision. Y. -x. Chen conceived the study, coordinated, and participated in the entire process of drafting, and revised the manuscript. S. Xia and E. -Q. Wang contributed to image evaluation and manuscript revision. M. -y. Luo assisted with language. All authors read and approved the final manuscript.

© 2018 by Ophthalmic Communications Society, Inc.