Sequential retinal pigment epithelium tears following intravitreal Ranibizumab injections for age-related macular degeneration

Purpose To report a case of sequential retinal pigment epithelium (RPE) tears following intravitreal Ranibizumab injections for neovascular age-related macular degeneration (AMD). Methods Retrospective, observational case Case description A 75-year-old hypertensive male was diagnosed with active neovascular AMD and pre-existing RPE tear in the left eye. His presenting best-corrected visual acuity was counting finger @ 1 metre, <N36 in the right eye and 6/9, N8 in the left eye respectively. The right eye fundus had a scarred choroidal neovascular membrane (CNV) with extensive hard exudates. The left eye fundus showed active CNV, subretinal fluid and haemorrhage and a large RPE tear inferior to the fovea with rolled up margins. Following treatment with intravitreal Ranibizumab injection (Accentrix (R), Alcon, 0.5 mg/0.05 ml) at monthly intervals, patient developed two extra RPE tears following each injection adjacent to the existing RPE tear. At the final follow-up visit, his CNV had regressed and visual acuity was maintained at 6/6, N6. No additional RPE tears were noted. Conclusion Pathogenesis of sequential RPE tears remains unclear. There is a need to look out for new RPE tears which can affect vision in a patient with neovascular AMD following CNV treatment.