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Purpose: To detect retinal pigment epithelium (RPE) tears in predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with intravitreal bevacizumab injections., Methods: Forty consecutive patients with predominantly classic CNV secondary to AMD were treated with 1.25 mg of intravitreal bevacizumab. Patients were evaluated with visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography., Results: Three patients developed a RPE tear after the first injection. The first patient had been treated with verteporfin therapy and VA remained unchanged. In the other two cases the CNV was naive and VA improved since the foveal center was not involved by the tear and macular edema was reduced., Conclusions: RPE tears can occur following intravitreal bevacizumab injections in patients with predominantly classic CNV although VA is not always affected.

Background: The development of tears of the retinal pigment epithelium (RPE) has classically been described with or without choroidal neovascularization (CNV) or after laser treatment. Tangential shear forces within the RPE or CNV are usually considered to cause the dehiscence., Methods: Three patients with CNV and spontaneous RPE tear and additional vitreomacular traction were examined by fluorescein angiography (FA), optical coherence tomography (OCT) and kinetic ultrasound., Results: From the pre-tear to the tear stage a sudden decrease in vision was observed. Fluorescein angiographic images demonstrated RPE-tear formation with blocked filling in the area of the contracted RPE and a well-demarcated hyperfluorescence in the bed of the torn RPE. OCT-scans demonstrated vitreomacular traction at the foveal area in all three cases. Kinetic ultrasound revealed vitreous attachments at the optic disc and fovea., Conclusion: Magnitude, variation of mechanical forces, and the continuous shear stress of the aged vitreous gel transmitted across vitreoretinal attachments may cause a chronic stimulus to retina and RPE. Vitreomacular traction may contribute to the subsequent formation of RPE tears via mechanical or cell mediator pathways.

Background: A peripheral retinal pigment epithelial tear and an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane are extremely rare. A peripheral retinal pigment epithelial tear has not been reported in an eye with retinochoroidal folds after blunt ocular trauma., Methods: Case report., Results: The course of a large nasal peripheral retinal pigment epithelial tear that occurred after blunt ocular trauma in a patient with retinochoroidal folds was followed. The inferior retinal detachment caused by leakage from the denuded Bruch's membrane following the development of the tear gradually worsened. Initial treatment with cryotherapy was ineffective, but the retinal detachment eventually resolved after the patient underwent sclerectomy and sclerostomy., Conclusion: A large peripheral retinal pigment epithelial tear can occur in patients with retinochoroidal folds following blunt ocular trauma, and extensive retinal detachment can be induced. Sclerectomy and sclerostomy can be beneficial in patients with an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane.

Purpose: In vitro and animal experiments were performed to evaluate the character of retina and pigment epithelium (RPE) damage induced by ultrasonic stream from the tip of a phacofragmentor and to establish the protective properties of perfluorocarbon liquid (PFCL)., Methods: During mechanical vitrectomy in 12 rabbit eyes, the retina were exposed to ultrasound from different distances and with different powers, with and without PFCL. Electron microscopic examination was then performed to assess damage., Results: Ultrasound failed to penetrate the layer of PFCL in vitro. In eyes not injected with PFCL, exposure to the stream from 2 mm and 4 mm at both 50% and 100% powers led to retinal hole formation within 45 to 155 seconds. Damage to the RPE was found in the projection of the hole and within 1 mm from its edge under intact retina. After exposure from 6 mm and in eyes injected with PFCL, the retina and RPE were unchanged., Conclusion: It is concluded that the ultrasonic stream from a phacofragmentor may damage the retina sufficiently to cause tears, but that the interface between perfluoro-n-octane and intraocular fluid provides a reflective surface that protects the posterior pole from the stream induced by ultrasound.

Tearing of the retinal pigment epithelium following trabeculectomy for chronic open-angle glaucoma in two patients is reported. In one patient, the tear was diagnosed on the 4th postoperative day. It started a few disc diameters above the temporal vascular arcade, crossed the temporal part of the macula and extended to the equator in the lower temporal periphery. At the acute stage, hypotonia and exudative retinal detachment were found. In the other patient, the tear was equatorial extending from the upper nasal to the lower nasal quadrant. At the acute stage, hypotonia and choroidal detachment, but no exudative retinal detachment, were present. After 1 year, the retina was flat in both eyes and no further complications were noted.