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The aim of this study was to investigate the occurrence, characteristics, management and prognosis of retinal pigment epithelium (RPE) tears in patients with polypoidal choroidal vasculopathy (PCV). Medical records of previous cases were reviewed over an eight-year period from a single centre in China. When RPE tears were identified, patients were treated with one injection of Lucentis combined with additional injections as needed if one of the following conditions were detected: 1) Visual deterioration of more than two lines (>0.2 logMAR); 2) OCT evidence of subretinal haemorrhage (SRH), intraretinal fluid, or submacular haemorrhage; 3) central foveal thickness (CFT) increase of more than 100 microns on OCT; 4) Leakage of polyps and / or branching vascular network lesions detected on FA and ICGA, or OCT. They found 33 PCV patients with RPE tears (8.3%) among 397 patients with detailed medical records. Patients were spilt into three groups: Group 1 (large subretinal haemorrhage without vitreous haemorrhage(VH)), Group 2 (patients with a VH) and Group 3 (patients without SRH or VH). The incidence of RPE tears was 23.8% in Group 1, 82.4% in Group 2, and 3.9% in Group 3. In 42.4% of these RPE tears happened spontaneously, 33% after anti-VEGF monotherapy, and 24.2% after combination therapy of photodynamic therapy (PDT) and anti-VEGF agents. Their treatment strategy showed patients’ BCVA improved significantly from 2.13 +/-1.24 (median 20/52) to 1.32 +/-1.31 (median 20/166) (p<0.05). The authors conclude that PCV is associated with high subRPE hydrostatic pressure, produced by a large pigment epithelial detachment (PED) or haemorrhage, which may not be entirely the same as the pathophysiology and mechanism of RPE tears in Type-1 nAMD.

The occurrence, characteristics, management, and prognosis of retinal pigment epithelium tears in patients with polypoidal choroidal vasculopathy: a retrospective study of 397 patients.
Zhao X, Xia S, Luo M, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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