Purpose
To assess the association of the vitreomacular interface (VMI) with outcomes in eyes treated with anti-VEGF drugs for neovascular age-related macular degeneration (AMD).
Methods
A prospective cohort study of the VMI in neovascular AMD was carried out within the<br /> Comparison of AMD Treatments Trials (CATT). In this multicenter randomized clinical trial, treatment was assigned randomly to either ranibizumab or bevacizumab and to 3 different regimens for dosing over a two-year period. Masked graders at a reading center assessed optical coherence tomography (OCT) scans at baseline and follow-up for vitreomacular traction (VMT) and adhesion (VMA), fluid and central thickness. Visual acuity (VA) was measured by masked, certified examiners. VA and anatomical features at baseline, 1 and 2 years, as well as number of treatments were compared between groups defined by VMT/VMA status at baseline or during follow-up.
Results
At baseline, 143 (12.8%) patient eyes had VMT or VMA. Compared to those with neither (N=972), patients with VMT or VMA were younger (mean (SE): 75.5 ±0.6 versus 79.7 ± 0.24 years, p<0.0001), more likely to be male (52.4% versus 36.2%, p=0.0003), cigarette smokers (68.5% versus 55.3%, p=0.003), and to have subretinal fluid on OCT (86.7% versus 81.0%, p=0.047). VMI status was not associated with VA at baseline or follow-up. Among eyes treated as needed (PRN, n=598) and followed for 2 years(n=516), the mean number of injections over 2 years was 15.4 ±0.9 for eyes having VMT at baseline or during follow-up (n=60), 13.8 ±0.7 for eyes with VMA at baseline or follow-up (n=79), and 12.9 ±0.4 (p=0.02) for eyes without VMT or VMA (n=377). In addition, the mean number of injections in eyes treated PRN increased from 13.0 ±0.3 when VMT was not observed, to 13.6 ±1.3 when observed once, to 17 ±1.2 when observe more than once during follow-up. At 2 years, geographic atrophy developed in a lower percentage of eyes with VMT or VMA at baseline (11.7%) than with neither condition (22.5%, p=0.005).
Conclusions
VMT and VMA were infrequent in eyes in the CATT. At baseline and follow-up, VMT or VMA were not associated with VA. Eyes with VMT or VMA treated PRN required on average 2 more injections over 2 years.