Retinal pigment epithelium tear after intravitreal aflibercept injection

Abstract

Masaaki Saito, Mariko Kano, Kanako Itagaki, Yasuharu Oguchi, Tetsuju Sekiryu Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan Abstract: To report a case complicated with a retinal pigment epithelium (RPE) tear after intravitreal aflibercept injection. A 78-year-old man had deteriorated visual acuity in his left eye. Fluorescein angiography showed occult choroidal neovascularization. Optical coherence tomography showed a serous retinal detachment and fibrovascular pigment epithelial detachment. He was diagnosed as typical age-related macular degeneration associated with pigment epithelial detachment and treatment consisting of three consecutive monthly intravitreal injections of aflibercept was planned. A month after the initial injection, his visual acuity had not improved. The red-free photograph showed an area of RPE defect inferior to the fovea. The fundus autofluorescence, fluorescein angiography, and optical coherence tomography clearly demonstrated the presence of an RPE tear. A second injection of aflibercept was performed due to a remaining serous retinal detachment. Although this is a single case and RPE tears may occur as a spontaneous complication of age-related macular degeneration patients, the risk of a tear should be discussed when considering aflibercept treatment for typical age-related macular degeneration patients with pigment epithelial detachment as there might be a risk for developing an RPE tear. Keywords: age-related macular degeneration, aflibercept, pigment epithelial detachment, retinal pigment epithelium tear