B RIEF R EPORTS Retinal Pigment Epithelium Tears After Intravitreal Bevacizumab in Pigment Epithelium Detachment Andreas W. A. Weinberger, Mirjam Thiel, Babak Mohammadi, Ioannis Theofylaktopoulos, Gabriele Thumann, and Peter Walter PURPOSE: To evaluate pigment epithelium detachment (PED) secondary to exudative age-related macular degen- eration (AMD) treated with intravitreal injection of bevacizumab with regard to incidence of retinal pigment epithelium tears (RIPs). DESIGN: Retrospective, interventional case series. METHODS: Institutional study of 31 eyes with PED in exudative AMD receiving intravitreal bevacizumab. Main outcome measures were Early Treatment of Dia- betic Retinopathy Study (ETDRS) visual acuity, PED vascularization and size measured by angiography and optical coherence tomography (OCT) imaging, and inci- dence of RIP. RESULTS: Vision improved in six eyes and remained stable in 22 eyes (follow-up, 12.3  10.3 weeks). Twenty- eight eyes showed a vascularized PED. Four eyes (12.9%) experienced an RIP without vision loss. All RIP cases were vascularized in more than 50% of total lesion size. CONCLUSIONS: In short-term follow-up, the risk for RIP after bevacizumab injection in eyes with PED seems to be moderately, but not statistically significantly, increased in PED lesions vascularized more than 50%. (Am J Ophthalmol 2007;144:294 –296. © 2007 by Elsevier Inc. All rights reserved.) I NTRAVITREAL INJECTION OF VASCULAR ENDOTHELIAL growth factor (VEGF) inhibitors is a widely used treat- ment of exudative age-related macular degeneration (AMD). The antibody fragment bevacizumab blocks all isoforms of VEGF-A and is approved by the Food and Drug Administration for intravenous application in colon can- cer patients. Rosenfeld and associates 1 were the first to report a favorable outcome after its use in AMD. Spaide and associates 2 reported 266 cases and noted significant improvement of visual acuity without short-term safety concerns. Recently, Meyer and associates 3 described two cases of tears in the retinal pigment epithelium (RIPs) after intravitreal bevacizumab injections in patients with preex- isting pigment epithelium detachment (PED) secondary to AMD. After institutional approval for intravitreal bevacizumab (1.25 mg) was given and informed consent obtained, patients with deteriorating visual acuity resulting from exudative AMD were offered treatment with bevacizumab. We reviewed their charts to identify the incidence and risk factors for an RIP in our patient series. We analyzed Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity changes, fluorescein angiography and indocyanine green angiography results, and optical coherence tomogra- phy (OCT) scans. In eyes with PED, angiograms, coexist- ing retinal angiomatous proliferations (RAPs), lesion diameter, PED height, and ETDRS visual acuity before and after treatment were assessed. For statistical analysis, the Fisher exact test was performed (significance level, .05). Among 178 patients treated with intravitreal bevacizumab for exudative AMD, 31 patients (17.4%) had an initial Accepted for publication Mar 15, 2007. From the Department of Ophthalmology, RWTH Aachen University, Aachen, Germany. Inquiries to Andreas W. A. Weinberger, Department of Ophthalmol- ogy, RTWH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany; e-mail: aweinberger@ukaachen.de FIGURE 1. Scattergram showing the logarithm of the mini- mum angle of resolution (logMAR) visual acuity before intra- vitreal injection of bevacizumab and at last follow-up. Symbols above the diagonal had decreased visual acuity at follow-up; those below the diagonal improved visual acuity. The dotted lines indicate the border of 15 letters (3 lines) of Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity. Hollow circles  one injection, no retinal pigment epithelial tear (RIP). Full circles  more than one injection, no RIP. Hollow squares  one injection, developed an RIP. None of the RIP cases had more than one injection. © 2007 BY ELSEVIER INC.ALL RIGHTS RESERVED. 294 0002-9394/07/$32.00