Anti-VEGF Drugs Do Not Differ in RPE Tear Risk for Wet AMD Eyes

Burden of retinal pigment epithelium (RPE) tears may not differ among the various anti-VEGF therapies used to treat patients with neovascular age-related macular degeneration (nAMD), according to new research.

In data from a team of Korea investigators, RPE tear incidence as well as relevant best-corrected visual acuity (BCVA) dependent on differing anti-VEGF agents were largely unaffected in patients receiving care for nAMD. The findings may provide greater assurance for ophthalmologists prescribing various agents in the leading nAMD drug class—at least in regard for the key safety outcome of RPE risk.

Led by Gisung Son, of the department of ophthalmology at HanGil Eye Hospital in the Republic of Korea, investigators conducted their analysis to interpret the visual prognostic factors of RPE tears and their clinical features. RPE tears are infrequent among patients with nAMD, though anti-VEGF treatment has been previously linked to increased risk of early tears, especially among patients receiving greater doses.

“Abundant clinical data on the treatment and prognosis of RPE tears are lacking,” they wrote. “A few studies have compared the occurrence, treatment, and prognosis of RPE tears in patients with nAMD after administration of bevacizumab, ranibizumab, or aflibercept, the 3 most popular intravitreal anti-VEGF injection agents.”

Son and colleagues conducted a retrospective, observational, comparative trial using medical records of patient eye RPE tears following anti-VEGF treatment from 2014 to 2019.

Investigators observed patient demographics and clinical characteristics including age, sex, their administered anti-VEGF agent, numbers of injections prior to and after RPE tear, and time between initial treatment and RPE tear. They additionally used patient BCVA, intraocular pressure (IOP) and central macular thickness (CMT) from each clinician visit.

The final assessment included 733 treatment-naive nAMD eyes from as many patients. Mean patient age was 74.5 years; mean follow-up duration was 20.3 months. Each eyes received a mean 5.3 injections. Anti-VEGF agents included in the analysis were bevacizumab (n = 281 eyes), ranibizumab (n = 163) and aflibercept (n = 289).

The team observed no significant differences in mean age, number of injections and follow-up duration among the 3 treatment arms. They observed RPE tears in only 10 eyes from 10 patients (1.36%). Median patient age among those who had an RPE tear was 76.5 years old; these patients were followed for a median 18.0 months.

Total RPEs occurred in 4 eyes from the bevacizumab group (1.42%), 2 from the ranibizumab group (1.23%), and 4 from the aflibercept (1.38%); the incidence rates were not significantly different across the 3 treatment arms (P = .985).

Patients with nAMD who had an RPE tear reported a mean pre- and post-event BCVA of 0.6 and 0.4, respectively—again, a non-significant difference (P = .436). CMT improved significantly among treated patients, from a mean 794.4 μm to 491.9 (P = .013).

Investigators concluded RPE tear incidence did not differ dependent on the type of anti-VEGF used to treat nAMD.

“The final BCVA was proportional to the BCVA before and after RPE tears,” they concluded. “Continuous treatment with anti-VEGF after the occurrence of RPE tears can benefit the final visual acuity and macular anatomy.”

The study, “Retinal pigment epithelium tears after anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration,” was published online in Ophthalmologica.