Management of retinal pigment epithelium tear during anti-VEGF therapy.

PURPOSE: This article aims to review current evidence on the development, diagnosis, and management of retinal pigment epithelium (RPE) tear during anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Literature searches were performed using MEDLINE/PubMed databases (cut-off date: August 2019). RESULTS: Three key recommendations were made based on existing literature and clinical experience. Multimodal imaging with color fundus photography, optical coherence tomography (OCT), near-infrared reflectance imaging, fundus autofluorescence imaging, OCT-angiography and/or fluorescein angiography are recommended to diagnose RPE tear and assess risk factors. RPE tears can be graded by size and foveal involvement. Patients at high risk of developing RPE tear should be monitored following each anti-VEGF injection. If risk factors worsen, it is not yet definitively known whether anti-VEGF administration should be more frequent, or alternatively stopped in such patients. Prospective research into high-risk characteristics is needed. After RPE tear develops, anti-VEGF treatment should be continued in patients with active disease (as indicated by presence of intra- or subretinal fluid), although cessation of therapy should be considered in eyes with multilobular tears. CONCLUSION: While evidence to support the assumption that anti-VEGF treatment contributes to development of RPE tear is not definitive, some data suggest this link.