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Effects of vitreomacular adhesion on anti-vascular endothelial growth factor treatment for exudative age-related macular degeneration

 Sung Jun Lee  ;  Hyoung Jun Koh 
 OPHTHALMOLOGY, Vol.118(1) : 101-110, 2011 
Journal Title
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Aged ; Angiogenesis Inhibitors/therapeutic use* ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized ; Bevacizumab ; Exudates and Transudates ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macula Lutea/physiopathology* ; Macular Degeneration/drug therapy* ; Macular Degeneration/physiopathology ; Male ; Ranibizumab ; Retrospective Studies ; Tissue Adhesions/physiopathology* ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors* ; Visual Acuity/physiology ; Vitreous Body/physiopathology*
OBJECTIVE: To evaluate the effect of posterior vitreomacular adhesion (VMA), documented by optical coherence tomography (OCT), on the outcome of anti-vascular endothelial growth factor (VEGF) treatment for exudative age-related macular degeneration (AMD). DESIGN: Retrospective comparative series. PARTICIPANTS: A total of 148 patients (148 eyes) who were newly diagnosed with exudative AMD and were treated by anti-VEGF in 1 eye from 2005 to 2008 with a minimum of 12 months follow-up. METHODS: We retrospectively reviewed OCT and medical records of 148 patients with exudative AMD and categorized them according to the presence of posterior VMA into 2 subgroups: VMA (+) group (38 eyes) and VMA (-) group (110 eyes). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after anti-VEGF treatment were compared between the 2 groups at baseline; at 1, 3, 6, and 12 months; and at the last visit (mean = 21 months). MAIN OUTCOME MEASURES: Mean changes in BCVA, which was converted to logarithm of the minimum angle of resolution (logMAR) values and CRT after anti-VEGF treatment. RESULTS: Mean BCVA significantly decreased over time in the VMA (+) group compared with the VMA (-) group (P = 0.039). At the last follow-up, mean BCVA had deteriorated from 0.87 logMAR (20/149 Snellen equivalent; baseline) to 0.98 logMAR (20/189 Snellen equivalent) in the VMA (+) group, but improved from 0.82 logMAR (20/132 Snellen equivalent, baseline) to 0.72 logMAR (20/104, Snellen equivalent) in the VMA (-) group (P = 0.028). In paired comparisons of BCVA between baseline and each follow-up visit, the VMA (-) group showed significant improvement of BCVA at every follow-up visit (P < 0.05); however, the VMA (+) group did not show significant visual improvement at any follow-up visit despite anti-VEGF treatment (P > 0.05). Comparison of mean CRT between baseline and each follow-up visit showed a statistically significant decrease at every follow-up in both groups (P < 0.05). CONCLUSIONS: Posterior VMA was associated with an inferior visual outcome after intravitreal anti-VEGF treatment for exudative AMD. Our results suggest that chronic tractional forces may antagonize the effect of anti-VEGF treatment, resulting in poor response to anti-VEGF treatment with patients with VMA.
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1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Koh, Hyoung Jun(고형준) ORCID logo https://orcid.org/0000-0002-5932-8516
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