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Valentina Sarao, Daniele Veritti, Paolo Lanzetta; Does the presence of vitreo-macular adhesion influence the outcome of anti-vascular endothelial growth factor therapy in patients with neovascular age-related macular degeneration? Systematic review and meta-analysis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5370.
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The presence of vitreo-macular adhesion has been supposed to negatively influence the outcome of anti vascular endothelial growth factor (VEGF) therapy. To determine if the presence of vitreous attachment has an effect on the functional outcomes in wet age-related macular degeneration (AMD), a systematic review and meta-analysis was conducted.
A PubMed MEDLINE database search was undertaken using Boolean operators with the following keywords: vitreomacular traction, taut posterior hyaloid, posterior vitreous detachment, vitreo-macular adhesion, ranibizumab, pegaptanib, bevacizumab, aflibercept. A total of 20 abstract were retrieved and reviewed by two authors (VS, DV). Only comparative studies describing visual acuity outcomes in patients with wet AMD depending on the state of the vitreo-macular adhesion were included. Eight studies were used for the analysis. Visual acuity data were converted to logarithm of the minimum angle of resolution units (logMAR). The results were pooled using mean difference (MD), a corresponding 95% confidence interval (CI).
Eight studies enrolling a total of 840 eyes affected by wet AMD were included in the meta-analysis. In five studies a beneficial effect of anti-VEGF therapy was seen independently of the state of the vitreous attachment to the macula. Meta-analysis showed that anti-VEGF treatment produced significantly better functional results in patients without vitreo-macular adhesion (MD 0.269, CI95% 0.091-0.447).
There are ambiguous data in literature reporting the association of vitreous attachment state and visual acuity outcomes after anti-VEGF for wet AMD. Meta-analysis demonstrated poorer response to anti-VEGF therapy in patients with vitreo-macular adhesion.
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