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Samuel K Houston, Nadim Rayess, Allen C Ho, Carl D Regillo; Influence of vitreomacular interface on anti-VEGF therapy using treat and extend treatment protocol for age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):290.
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The purpose of this study is to determine the influence of the vitreomacular interface (VMI) on treatment outcomes in patients with neovascular age-related macular degeneration (AMD) who are treated with anti-VEGF agents using a treat and extend protocol.
This study is a retrospective, observational, case series of patients diagnosed with neovascular AMD who were treated at Mid Atlantic Retina (MAR), the Retina Service of The Wills Eye Institute, Philadelphia, PA from January 1, 2009 to December 1, 2013. Following IRB approval, patient records were reviewed for age, gender, visual comorbidities, visual acuity (baseline, year 1), anti-VEGF treatment history, OCT central retinal thickness (CRT), and OCT evaluation of vitreomacular interface.
A total of 64 (43 female, 21 male) treatment-naïve patients with neovascular AMD were reviewed, with a mean age of 80.4 years. 49 patients (77%) did not have evidence of vitreomacular adhesion or traction (non-VMA), while 15 patients (23%) did have evidence of VMA or VMT. Baseline mean VA in the non-VMA group was 20/98 with a mean CRT of 312 microns. Mean VA at year 1 in the non-VMA group was 20/66 with a mean CRT of 264 microns. Baseline mean VA in the VMA/VMT group was 20/162 with a mean CRT of 348 microns. Mean VA at year 1 in the VMA/VMT group was 20/67 with a mean CRT of 308 microns. Mean total number of injections at year 1 for the non-VMA group was 7.57 versus 8.7 (P = 0.028) for the VMA/VMT group. The mean interval between injections in the non-VMA group was 7.5 weeks versus 6.27 weeks (P = 0.022). The mean longest interval between injections in the non-VMA group was 11.4 weeks compared to 9.1 weeks (P = 0.017) in the VMA/VMT group.
The vitreomacular interface (VMI) appears to have a significant influence on anti-VEGF treatment intervals and should be assessed when using a treat-and-extend protocol. VMA/VMT on OCT may require more intensive treatment with decreased ability to extend treatment intervals.
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