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U. Sponer, C. Simader, I. Golbaz, M. Ritter, M. Bolz, C. Ahlers, M. Baratsits, U. Schmidt-Erfurth; Does Type of Posterior Vitreous Attachment Influence Anti-VEGF Therapy?. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1891.
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To determine a potential influence of posterior vitreous attachment on the response to anti-angiogenetic treatment in exudative Age-related Macular Degeneration (AMD).
A hypothesis generating study was performed analyzing spectral-domain optical coherence tomography (SDOCT) scans (Cirrus©, Carl Zeiss Meditec) and descriptions of indirect slitlamp biomicroscopy of 24 patients enrolled in double-blinded prospective anti-VEGF trials. These included patients older than 50 years with active, subfoveal choroidal neovascularisation secondary to AMD, naive to treatment and a best corrected visual acuity (BCVA) letters score between 24 and 73. All patients received a ranibizumab therapy consisting of a loading dose of 3 monthly intravitreal injections.The type of posterior vitreous attachment was determined at baseline and 3 months after treatment initiation; group A: patients with totally adherent vitreous; group B: vitreous attached at the fovea and perifoveal detachment; group C: complete posterior vitreous detachment (PVD). Groups were compared regarding at changes in central retinal thickness (CRT) measured with SDOCT and changes in BCVA letters using ANOVA and post hoc testing.
At baseline, 12.5% of all patients belonged to group A, 33.3% had a perifoveal detached vitreous (B) and 54.2% showed complete PVD (C). Status of the vitreous was stable from baseline until month 3 in all patients. Patients experienced a significant improvement in BCVA letters (students t test T =-4.456, p<0.001) and a significant decrease in CRT during the first 3 months (T =4.369, p<0.001). Comparing the groups with different type of vitreous attachment no significant difference of the therapeutic effect on retinal morphology or function was observed (BCVA: ANOVA F =3.61, p> 0.05, Bonferroni pA/B =0.069, pA/C=0.757, pB/C =0.170; CRT F =1.096 p>0.05, Bonferroni pA/B =1.0, pA/C =0.511, pB/C =1.0).
The results suggest that the type of vitreous attachment at the posterior pole does not severely influence morphologic or functional retinal treatment effects of a monthly anti-VEGF therapy throughout a three months observation period.
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