- Study Focus: Examines the association between retinal pigment epithelium tear (RPET) and anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (NV-AMD).
- NV-AMD Characteristics:
- Leads to severe vision loss, especially when the fovea is affected.
- Characterized by choroidal neovascularization, causing fluid accumulation, bleeding, and macular fibrosis.
- Spontaneous RPET can occur due to hydrostatic pressure from subretinal fluid in retinal pigment epithelial detachment (PED).
- Anti-VEGF Therapy:
- Gold standard for NV-AMD treatment (e.g., bevacizumab, ranibizumab, aflibercept).
- Some studies suggest anti-VEGF therapy may induce RPET by causing choroidal neovascularization involution and tractional forces on RPE layers.
- Study Objective: To explore the incidence of RPET during anti-VEGF therapy and assess whether continued therapy benefits patients with RPET.
- Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched MEDLINE, Web of Science, and Embase for studies on RPET and anti-VEGF therapy.
- Included studies with ≥100 patients for RPET incidence and no sample size restrictions for visual acuity changes.
- Data extracted: study details, patient demographics, follow-up time, RPET incidence, and visual acuity changes.
- Risk of bias assessed using ROBINS-I and ROB2 tools.
- Statistical analysis performed using R software, with subgroup analyses and meta-regression to identify heterogeneity sources.
- Results:
- RPET Incidence: Pooled incidence of RPET after anti-VEGF therapy was 1.9% (95% CI: 1.3–2.7) across 24 studies (17,354 patients).
- PED Association: 12.7% of patients with PED at baseline developed RPET; 95.9% of RPET cases had PED.
- Time of RPET: Most RPET cases occurred within the first month after the first anti-VEGF injection.
- Visual Acuity: Continued anti-VEGF therapy stabilized visual acuity in RPET patients, with a trend toward improvement (SMD: 0.34; 95% CI: −0.03 to 0.71).
- Subgroup Analysis: Longer follow-up (>1 year) correlated with higher RPET incidence. No significant differences based on anti-VEGF type, dose, or number of injections.
- Discussion:
- Anti-VEGF therapy may accelerate RPET in predisposed patients but does not increase overall incidence.
- Patients with PED are at higher risk of RPET; clinicians should weigh risks and benefits of anti-VEGF therapy in these cases.
- Continued anti-VEGF therapy may stabilize or improve vision in RPET patients, particularly in lower-grade tears.
- Limitations include lack of control groups for RPET incidence and reliance on retrospective data for visual acuity outcomes.
- Conclusion:
- RPET incidence after anti-VEGF therapy is low, with most cases occurring early in treatment.
- Continued anti-VEGF therapy can stabilize visual acuity in RPET patients, supporting its use despite RPET occurrence.
Supplemental Digital Content: Includes detailed search strategies, study characteristics, bias assessment, and additional analyses.
