Retrospective research conducted at Mayo Clinic in Rochester, Minn., explored the clinical and imaging features of eyes with and without vitreomacular interface disease (VMID) that were treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for exudative age-related macular degeneration (AMD).
Several factors — including genetic and environmental inputs, oxidative stress, inflammation, and ischemia — have been explored as major contributors to the disease process of AMD, but its origins and effects continue to be incompletely characterized. Recent studies have also examined the vitreoretinal interface as an important element in the origins and effects of AMD. Indications include the following:
- Posterior vitreous detachment is considerably less common in eyes with AMD than in eyes without disease.
- Persistent attachment of the posterior vitreous cortex to the macula is more common in eyes with exudative AMD than in control eyes and eyes with nonexudative AMD.
The Mayo Clinic study
"There were no longitudinal data describing patients with VMID undergoing treatment for exudative AMD. Our aim was to describe clinical and imaging features of this group of patients, observed over the four-year period since the widespread initiation of anti-VEGF therapy," says Sophie J. Bakri, M.D., of the Department of Ophthalmology at Mayo Clinic in Minnesota and the principal investigator of the study.
The research team identified 178 patients who received a diagnosis of exudative AMD from Dr. Bakri and who were treated with anti-VEGF injection between Jan. 1, 2005, and Dec. 31, 2009. These patients met the following inclusion criteria:
- Age 50 years or older at the time of their initial visit
- Available results of an optical coherence tomographic examination
- Available data from at least one year of follow-up
Exclusion criteria included a history of any vitreoretinal surgery, retinal detachment, diabetic retinopathy, macular hole, uveitis, vascular occlusion, or myopia greater than negative 2 diopters.
Of the study patients, 146 had eyes with no traction and 32 had vitreomacular interface disease in the study eye. Of these 32 patients, 15 eyes had vitreomacular traction; 17 patients had a diagnosis of an epiretinal membrane. The patients were monitored for an average of approximately 2.5 years. Their medical records were reviewed for best-corrected visual acuity, manually measured central foveal thickness from optical coherence tomographic imaging, and the number and timing of intravitreal anti-VEGF injections.
Implications for future studies
The study indicated that the induction of a complete PVD may not be necessary for improvement in either best-corrected visual acuity or anatomic outcome. Continued tractional forces on the retina did not appear to limit visual acuity or anatomic improvement, although the presence of a PVD may allow the retinal thickness to respond better to treatment with each anti-VEGF injection.
"We found that, among eyes with VMID, the anti-VEGF therapy yielded improved best-corrected visual acuity and decreased central foveal thickness despite continued traction. Eyes with VMID did require more anti-VEGF agents than eyes without VMID," says Dr. Bakri. "If confirmed in larger prospective studies, these results will have important implications for the treatment of exudative AMD in patients with VMID."
For more information
Dr. Bakri presented these research results at the 2012 annual meetings of the American Society of Retina Specialists and The Retina Society. The report, "Visual and Anatomic Outcomes of Anti-VEGF Therapy in Exudative Age-Related Macular Degeneration and Vitreomacular Interface Disease: Vitreomacular Adhesion and Epiretinal Membrane," will be published in an upcoming issue of Retina.
Points to remember
- Several factors have been explored as major contributors to the disease process of age-related macular degeneration (AMD), including genetics, environment, oxidative stress, inflammation and ischemia.
- Recent studies have also examined the vitreoretinal interface as a contributor, but there were no longitudinal data describing patients with vitreomacular interface disease (VMID) undergoing treatment for exudative AMD.
- A retrospective study found that, among eyes with VMID, anti-vascular endothelial growth factor therapy improved best-corrected visual acuity and decreased central foveal thickness despite continued traction.