gms | German Medical Science

Purpose: Tears of the retinal pigment epithelium (RPE) may cause severe visual loss and occur either spontaneously or during anti-VEGF therapy of age-related macular degeneration (AMD). We determined morphological alterations with high-resolution imaging and assessed fundus autofluorescence (FAF) abnormalities in the border zone.

Methods: Serial examinations in patients with RPE tears were performed using simultaneous confocal scanning laser ophthalmoscopy (cSLO) and spectral-domain optical coherence tomography (SD-OCT; Spectralis, Heidelberg Engeneering). Morphological alterations were quantified by two independent readers using image processing methods. Qualitative evaluations were analyzed in volume scans covering the affected area. Abnormalities in the border zone on FAF images (em. 488 nm, exc. >500 nm) were compared to FAF in geographic atrophy.

Results: 14 eyes of 14 patients (mean age 76.75±4.97 years) with recordings from 1 to 48 months were retrospectively analyzed. The mean extrafoveal retinal thickness over the area of torn RPE was 239±51 µm (range 178 to 333 µm). In the area of denuded Bruch’s membrane hyperreflective structures of variable vertical extensions were observed in 10 eyes (71 %). Integrity of corresponding retina was evident in 8 out of 10 eyes. On FAF the junctional zone showed either no or single signal increments.

Conclusions: The results indicate a remodelling process over the denuded Bruch’s membrane. The preserved retinal microarchitecture may support previous assumptions of cells with RPE-like functions able to maintain survival of neurosensory retina. FAF abnormalities of the junctional zone differed from patterns in geographic atrophy indicating a different cellular and molecular response to lacking neighbouring RPE cells.