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F. A. Rezende, M. C. Kickinger, R. F. Prado; Vitreomacular and Photoreceptor-Retinal Pigment Epithelium Interface Relationships in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):520.
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To describe vitreomacular and photoreceptor-retinal pigment epithelium (RPE) interface relationships in age-related macular degeneration (ARMD) of treated and non-treated eyes.
A prospective, observational case series of 204 eyes of 102 patients with the clinical diagnosis of ARMD was performed between January 2005 and December 2008. All patients underwent time-domain optical coherence tomography (TD-OCT) evaluation of the vitreomacular and photoreceptor-RPE interface by a single examiner at the Department of Ophthalmology, Pontifícia Universidade Católica, Rio de Janeiro, Brazil. The eyes were divided in age-related maculopathy (early ARMD), dry ARMD (geographic atrophy), and exudative ARMD (choroidal neovascular membrane, RPE detachment, and disciform scar). Eyes with vitreomacular interface abnormalities were followed after surgical intervention. Main outcome was number of eyes with vitreomacular interface abnormalities and early post-operative photoreceptor-RPE disturbances in operated eyes.
Of the 204 eyes, 75 eyes (36.8%) had age-related maculopathy, 89 eyes (43.6%) had exudative ARMD, and 40 eyes (19.6%) had dry ARMD. Among the eyes with vitreomacular adhesions detected by TD-OCT, 34 eyes (16.7%) had vitreomacular traction syndrome, 16 eyes (7.8%) had epiretinal membrane (ERM), 2 eyes (0.98%) had full-thickness macular hole, and 31 eyes (15.2%) had perifoveal posterior vitreous detachment without macular traction. Twelve eyes were operated: 2 of 2 eyes with macular holes closed despite choroidal neovascular membrane (CNV) reactivation; 4 vitreomacular traction syndrome were operated without any complications; of the 6 epiretinal membranes (5 eyes with age-related maculopathy and one eye with CNV at the time of surgery), 2 developed intra-operative RPE tear temporal to the macula, 1 developed a new small subfoveal CNV one month post-operative, and 3 had no complications.
We found similar results in our series of brazilian patients with ARMD compared to northern hemisphere series. To the best of our knowledge, no previous reports have found intra-operative iatrogenic RPE tears during ERM removal in age-related maculopathy. Further studies on the vitreomacular and photoreceptor-RPE interface are required to better elucidate their relationships.
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