Retinal Assistant Module Blog

Seventy-six years old female phakic presented to me with reduced vision. Her BCVA is 20/40 in her right eye, while in her left eye, the BCVA is 20/30 fundus examination showed drusen. Fundus examination shows drusen, RPE elevation, and subretinal fluid, while OCT features PED with smooth RPE elevations, which contains clear fluids that look like homogeneous hyporeflective area, subretinal fluids accompanied by ellipsoid zone disruption, and drusen. The patient was treated with seven Ranibizumab injections and maintained BCVA 20/40 with reduced PED volume and persistent subretinal fluid. The patient received the 8th injection and reduced vision to 20/150. OCT shows RPE tear, which indents the retina and increases hyperreflectivity in the area of contracted RPE with underlying shadowing hinders choroidal view in contrast to the area where RPE where it ripped off which only Bruch's membrane is visible and increasing the visibility of the underlying choroid. Diagnosis Wet ARMD with ser...

RPE tear can occur in vascularized PEDs due to a complication of intravitreal AntiVEGF treatment, which causes a rapid contraction of CNVm, inducing traction on the RPE surface and shrinking of RPE surface. On OCT, the RPE rip will indent the retina with increased hyperreflectivity in contracted RPE with underlying shadowing hinders choroidal view in contrast to the area where RPE where it ripped of which only Bruch's membrane is visible and increasing the visibility of the underlying choroid. RPE tear Thus two opposite forces, the regression of CNVm and remaining attached RPE, other causes such as laser or spontaneous can occur. However, the AntiVEGF treatment continued despite the RPE tear. Please check  Clinical guidelines for ARMD  and  course of clinical changes in RPE