Intravitreal Anti-Vascular Endothelial Growth Factor Agents in Patients with Neovascular Age-Related Macular Degeneration and Retinal Pigment Epithelial Tear: A Systematic Review and Meta-Analysis

The purpose of this systematic review and meta-analysis is to evaluate the outcomes of continuing versus discontinuing intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment at various follow-up time-points in neovascular age-related macular degeneration (nAMD) patients who developed retinal pigment epithelium (RPE) tears following anti-VEGF therapy. Relevant publications were identified through a systematic search in the PubMed and EMBASE databases. The standardized mean differences (SMD), with their 95% confidence intervals (95% CI), were estimated using random effects models (DerSimonian-Laird), as appropriate. Meta-regression analysis was also performed. Thirty studies (including 479 eyes with RPE tear) were eligible for the systematic review and meta-analysis. These studies examined the outcomes in patients who continued anti-VEGF treatment post-tear and those who discontinued it, with comparisons made separately for different timepoints in each group. In patients who continued anti-VEGF treatment, the pooled best-corrected visual acuity (BCVA) showed no statistically significant difference compared to baseline at any time-point of the follow-up. The pooled central subfield thickness (CST) improved at 12 months, but did not reach a significant level (SMD −0.45; 95% CI: −0.99, 0.10, I² = 49.5%, <i>p</i> = .159). Long-term follow-up indicated a decrease in the presence of subretinal and intraretinal fluid. In patients who discontinued intravitreal anti-VEGF treatment, there was a non-significant improvement in BCVA within the first 3 months; however, BCVA fluctuated or worsened over time, and fibrosis development was observed. This systematic review and meta-analysis found that intravitreal injections of anti-VEGF do not significantly impact visual acuity in patients with RPE tears at various follow-up timepoints, but may provide anatomical improvement. Retinal pigment epithelium (RPE) tears are a serious complication in neovascular age-related macular degeneration (nAMD) patients, often leading to significant visual loss, and their incidence has risen with increased anti-vascular endothelial growth factor (anti-VEGF) use.This systematic review and meta-analysis found that continuing anti-VEGF therapy after an RPE tear does not significantly improve visual acuity but may provide anatomical improvement over time.Continuing anti-VEGF therapy after RPE tear may reduce central subfield thickness (CST) and subretinal fluid (SRF), but does not prevent the development of fibrosis, highlighting the complexity of treatment decisions. Retinal pigment epithelium (RPE) tears are a serious complication in neovascular age-related macular degeneration (nAMD) patients, often leading to significant visual loss, and their incidence has risen with increased anti-vascular endothelial growth factor (anti-VEGF) use. This systematic review and meta-analysis found that continuing anti-VEGF therapy after an RPE tear does not significantly improve visual acuity but may provide anatomical improvement over time. Continuing anti-VEGF therapy after RPE tear may reduce central subfield thickness (CST) and subretinal fluid (SRF), but does not prevent the development of fibrosis, highlighting the complexity of treatment decisions.