Clinical associations and prognostic implications of repair tissue proliferation in eyes with retinal pigment epithelium tears

Purpose: To investigate demographic and clinical factors influencing the longitudinal changes of retinal pigment epithelium (RPE) dehiscence area after RPE tears, including the presence of RPE tear-associated repair proliferation (TARP), and identify factors associated with TARP development over follow-up. Methods: Retrospective, single-center, observational cohort study of patients with a history of macular neovascularization and RPE tear. The area of RPE dehiscence was measured on repeated short-wavelength fundus autofluorescence imaging. Associations between potential covariates and RPE dehiscence areas were tested with multivariable linear mixed models. Associations between TARP development and clinical variables were investigated with Cox regression models. Factors associated with visual acuity changing rates were explored with linear mixed models. Results: Thirty-seven eyes of 36 patients were included in this study and followed for a median time of 18 months. TARP was identified in 27 eyes (73%). The median time for TARP detection was 112 days; none of the investigated factors was significantly associated with TARP occurrence. The presence of TARP (β estimate: -0.042 mm2/month, p=0.001) and female gender (β estimate: -0.035 mm2/month, p=0.006) were associated with slower rates of RPE dehiscence enlargement over time. Faster rates of visual improvement were seen in eyes with TARP compared with those without TARP (β = -0.010 LogMAR/month if TARP was present, p=0.008). Conclusion: RPE tear repair with TARP and female gender were associated with slower RPE degeneration after RPE tears. The presence of TARP was associated better visual prognosis. Additional research on factors promoting TARP development may have therapeutic and prognostic implications.